HIV medications reduce transmission risk

HIV: Early use of medication reduces transmission risk

13/05/2011

If HIV-infected people start medication immediately after diagnosis, the risk of infection for their partners can be significantly reduced. This is the result of a study funded by the National Institute of Allergy and Infectious Diseases since 2005, which has been monitoring the transmission risk since 2005 for just under 1,800 couples, one of whom was HIV-infected at the beginning of the study.

The study was supposed to run until 2015, according to the World Health Organization (WHO), but given the looming outcome, the study was discontinued to protect non-HIV infected partners from infection. After all, the risk of infection was 96 percent lower for those subjects whose HIV-infected partners were taking antiretroviral drugs immediately after diagnosis than for the study participants who did not receive any medical treatment.

AIDS study with nearly 1,800 couples
According to the representative study, since 2005, a total of 1,763 couples in which one partner was HIV-infected have been observed, according to the National Institute of Allergy and Infectious Diseases. The study participants came from thirteen cities in Botswana, Brazil, India, Kenya, Malawi, Zimbabwe, South Africa, Thailand and the United States and were 97 percent heterosexual. The HIV-infected subjects had already been diagnosed, but no antiretroviral therapy had begun, the researchers said. Participating couples were randomly cut in half and the HIV-infected partners in one group received antiretroviral drugs from the beginning of the study. The other couples, on the other hand, had to manage without adequate medication, as long as there were no signs of weakening of the immune system in the blood picture or other AIDS symptoms. All study participants received condoms, safe sex advice, and treatment for other sexually transmitted diseases, the researchers reported.

Antiretroviral treatment reduces HIV infection risk
So far, the study has infected 39 subjects with HIV, of which 28 were definitely infected by their partner, said the experts of the National Institute of Allergy and Infectious Diseases. One of the reasons for the discontinuation of the study was that 27 of the 28 HIV infections in the group were treated without antiretroviral treatment. The control group had to be dissolved in order to enable HIV-infected people in this group to undergo drug treatment, thus minimizing the risk of infection for their healthy partners, the researchers said. „This is a significant development because we know that 80 percent of all new infections take place through sexual transmission“, said Margaret Chan, Director-General of the World Health Organization (WHO). The findings of the study will also feed into the new WHO guidelines on AIDS, which are expected to be published in July, the WHO Director-General said. Study leaders Anthony Fauci of the National Institute of Allergy and Infectious Diseases and Myron Cohen of the University of North Carolina at Chapel Hill said that although the study itself is now over since the peer groups have been disbanded, it is the long-term health effects of antiretroviral drugs The participants will continue to be monitored.

New WHO guidelines planned in the fight against AIDS
Although antiretroviral therapy significantly reduces the risk of transmission of HIV to healthy partners, researchers have found that these drugs are often associated with serious side effects. So far, the WHO recommendation is to treat HIV patients only when the number of so-called CD4 helper cells in the blood has dropped to a maximum of 350 per milliliter or less. With the outbreak of the immunodeficiency syndrome AIDS, the number of corresponding helper cells, which normally averages 600 per milliliter, drops drastically. However, the use of antiretroviral drugs even before the decline of the CD4 helper cell, can offer significant benefits not only in the interests of patients, but also in the interests of their partners, the current study. In most industrialized countries, doctors recommend a drug treatment from as little as 500 CD4 helper cells per milliliter of blood anyway.

Significant side effects of HIV medication
However, the side effects of antiretroviral drugs should not be underestimated. According to the experts, nausea, diarrhea and feelings of weakness as well as long-term painful inflammation of the nerves in the limbs, disturbances of lipid metabolism and, at worst, organ damage and even liver failure are the possible consequences of antiretroviral drugs. HIV-infected people can choose between the bigger and the smaller evil. They either refrain from drug treatment for fear of side effects, putting their partners at significantly higher risk of infection, or protect their partner by taking antiretroviral medicines early, potentially damaging their own health. However, Thomas Coates, founder of the Center for AIDS Prevention Studies in San Francisco, told the New York Times that he hopes that more and more HIV-infected individuals will start early on with drug treatment to protect their partners. The risk of side effects is not to be overlooked, but the latest means are much better tolerated than previous preparations, the expert said.

AIDS prevention by drug treatment?
According to Michel Sidibé, director of the Joint United Nations Program on HIV / AIDS (UNAIDS), the results of the current study should also help end the debate on how to finance the drugs as a precautionary measure. „The distinction between treatment and prevention is not real“, Sidibé emphasized, demanding that all affected couples now gain access to this form of drug prevention. Worldwide, according to the expert, more than 33 million people are infected with HIV, with two-thirds living in sub-Saharan African countries. In Germany, according to the Robert Koch Institute (RKI), a total of about 70,000 suffer from AIDS and annually add about 3,000 HIV infections. In contrast to the recently introduced AIDS preventive drugs, which are to be administered to healthy people to prevent infection and had a safety of 73 percent, the antiretroviral treatment of the infected with a reduction of the risk of infection for partners by more than 90 percent is a far more promising strategy in the fight against HIV, Stefan Esser, Aids researcher from the University Hospital Essen, last year in the run-up to the World AIDS Day. (Fp)

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