Tuesday, July 26, 2011

Treatment Impacts Prevention

In a New England Journal of Medicine article, published on July 18, 2011, Dr. Myron Cohen of the University of North Carolina, Chapel Hill and his colleagues make the case for "early" treatment of HIV as a means of HIV prevention. In their study, they looked at nearly 2000 serodiscordant couples (one partner HIV+, one HIV-), predominantly from Africa. HIV medication was given to half of the HIV positive partners while treatment was deferred in half until the CD4 count dropped or development of HIV related symptoms-- the standard of care in these areas without enough medication for everyone. The goal of the study was to see if this "early" treatment would result in fewer infections among their HIV negative partners (while also monitoring them to see if early treatment made a difference in the positive partners' health).
The result was that of the 28 infections that were proven to be transmitted from one partner to the other, only 1 was in the treatment group. Individuals on treatment also had fewer HIV related clinical problems.
In a companion editorial in the same issue, Dr. Scott Hammer of Columbia University makes the case for expanded access for medications, "this is precisely the wrong time to limit access to antiretroviral therapy in resource-limited settings, since we have the tools in hand to maintain or restore health in infected persons and reduce transmission to their sexual partners."

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