{"id":953,"date":"2010-05-27T15:00:58","date_gmt":"2010-05-27T19:00:58","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=953"},"modified":"2015-06-04T15:25:08","modified_gmt":"2015-06-04T19:25:08","slug":"hiv-treatment-is-prevention","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/hiv-treatment-is-prevention\/2010\/05\/27\/","title":{"rendered":"HIV Treatment is Prevention!"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright size-full wp-image-954\" title=\"einstein\" src=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2010\/05\/einstein1.jpg\" alt=\"einstein\" width=\"285\" height=\"151\" \/>The <em>Lancet<\/em> has <a href=\"http:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(10)60705-2\/fulltext\" target=\"_blank\">just published<\/a>\u00a0a large prospective study demonstrating the protective effect of HIV treatment on the risk of viral transmission:<\/p>\n<blockquote><p>3381 couples were eligible for analysis &#8230; Only one of 103 genetically-linked HIV-1 transmissions was from an infected participant who had started ART, corresponding to transmission rates of 0\u00b737 (95% CI 0\u00b709\u20142\u00b704) per 100 person-years in those who had initiated treatment and 2\u00b724 (1\u00b784\u20142\u00b772) per 100 person-years in those who had not\u2014a 92% reduction (adjusted incidence rate ratio 0\u00b708, 95% CI 0\u00b700\u20140\u00b757, p=0\u00b7004).<\/p><\/blockquote>\n<p>A similar observation was made in an earlier\u00a0study <a href=\"http:\/\/www.retroconference.org\/2009\/Abstracts\/36517.htm\" target=\"_blank\">presented at CROI 2009<\/a>, not yet published.\u00a0\u00a0Astoundingly, the rate\u00a0of transmission\u00a0in this <em>Lancet<\/em> paper could\u00a0have been\u00a0be zero if analyses were limited only to those with undetectable viral loads on treatment.\u00a0<\/p>\n<p>So\u00a0here&#8217;s the bottom line:\u00a0 HIV treatment dramatically, hugely, <a href=\"http:\/\/www.google.ie\/dictionary?hl=en&amp;sl=en&amp;tl=en&amp;q=ginormous\" target=\"_blank\"><em>ginormously<\/em><\/a>\u00a0reduces the\u00a0risk of HIV transmission.\u00a0<\/p>\n<p>(My daughter several years ago predicted that ginormous would become a word.\u00a0 <a href=\"http:\/\/www.usatoday.com\/life\/books\/2007-07-10-dictionary-new-words_N.htm\" target=\"_blank\">She was right<\/a>.)<\/p>\n<p>Yes,\u00a0we can quibble with some of the details &#8212; the 2009 study did not include viral load measurements, this one in the <em>Lancet<\/em> was actually part of a study of HSV treatment hence the results are observational, protection from infection\u00a0is not 100%\u00a0&#8212; but is there any doubt that HIV treatment is\u00a0currently our most effective way of preventing the spread of HIV?<\/p>\n<p>Some will say that the definitive study on this issue is <a href=\"http:\/\/www.hptn.org\/research_studies\/HPTN052.asp\" target=\"_blank\">HPTN 052<\/a>, which randomizes the HIV-infected member of a serodiscordant couple to go on treatment or to wait until the CD4 cell count drops below 250.\u00a0 The primary endpoint is the rate of infection\u00a0among the seronegative partners.<\/p>\n<p>But that\u00a0study is likely to exclude those most likely to transmit HIV, since it&#8217;s limited to people with HIV who have no symptoms, a relatively high CD4 cell count, and hence on average\u00a0a lower viral\u00a0burden.<\/p>\n<p>At this point, it seems a no-brainer to me.\u00a0 Treatment <em>is<\/em> prevention.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The Lancet has just published\u00a0a large prospective study demonstrating the protective effect of HIV treatment on the risk of viral transmission: 3381 couples were eligible for analysis &#8230; Only one of 103 genetically-linked HIV-1 transmissions was from an infected participant who had started ART, corresponding to transmission rates of 0\u00b737 (95% CI 0\u00b709\u20142\u00b704) per 100 [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,5,8,10],"tags":[77,244,423,464,553,750],"class_list":["post-953","post","type-post","status-publish","format-standard","hentry","category-hiv","category-infectious-diseases","category-patient-care","category-research","tag-antiretroviral-therapy","tag-croi","tag-hiv","tag-hptn-052","tag-lancet","tag-prevention"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/953","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=953"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/953\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=953"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=953"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=953"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}