Sunday, May 15, 2011

HIV Treatment is HIV Prevention

This week saw big news in the HIV community. A study of discordant couples (in which one partner is HIV + and the other is not) has shown that when the HIV+ partner is on anti-retroviral therapy, the risk of viral transmission is lowered. By 96%. The results were so striking that the study was ended four years ahead of schedule. What would be the point of continuing, when you already know the answer: HIV treatment is prevention.

Read the Wall Street Journal article here.

This is important news as it gives some scientists and doctors hope that maybe we can outsmart this very clever virus. The results seem to imply that more testing and more treatment could possibly slow down transmission rates in a dramatic way - something that abstinence and condoms have been unable to do on their own.

The study results are also a weapon against those who question allocating resources towards treatment, suggesting instead that more resources go towards prevention methods (like abstinence and condom campaigns). Now it seems clear that good treatment is also prevention - it protects the negative partners of HIV+ people. Now there is less reason to have to decide between the two.

Michael Specter, a public health journalist, writes in a short article about the study that some in the health community are already asking the difficult questions. Will this news make HIV+ people on treatment less careful about unprotected sex? There have always been people who have questioned HIV treatment, arguing that resources should instead be given to increasing prevention efforts. There are also those in our society who feel HIV is a result of poor personal decisions and that the enormous financial cost of treatment is a waste.

For some reason, there are people who relish a fatal STI because they can use it to scare people into believing sex is sinful. STIs are terrible diseases, but they are not punishments from above and we should not humor those who want to use STIs to their advantage while on moral campaigns against human nature.

It seems that this news may have some influence on the current CDC and WHO recommendations for the commencement of anti-retroviral treatment. An HIV negative person might have a CD4 count between 500 and 1,500. Many HIV positive people also have CD4 counts around 500. Generally, someone is not diagnosed with AIDS until they have a CD4 count of 200 or lower. One goal of HIV treatment is to prevent the onset of AIDS in HIV positive patients. Currently, the commencement of anti-retroviral treatment is recommended for a CD4 count of 350 or less, but even last year I attended a lecture, sponsored by a drug company, that showed a study of patients who began treatment at a CD4 count of 500. It was already known that beginning treatment earlier is better for patients. With this new study, we find that it is better for their partners as well.

Still, there are caveats. Besides being expensive, treatment is a life-long commitment. Once you start, you should not stop because of the risk of resistance. Drug-resistant HIV is a very real issue. Once the virus forms resistance to one class of drugs, it greatly narrows the treatment choices left. And taking these pills is hard. They come with side-affects like diarrhea, nightmares, vomiting. They are daily reminders that you are living with a fatal, contagious disease - just the act of taking the pills depresses some patients. Doctors often want to delay treatment until it is necessary, to reduce the risk of non-compliance.

Treatment is not simple. Certainly, it will always be better to prevent infection altogether. But HIV is here, and we must deal with it as it is. This study should support increased funding for treatment and a move to earlier treatment - as a prevention method.

Related Posts:

ADAP Mishap: Who Will Have Access to HIV Medications in this Economy?
All HIV/AIDS Posts

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