Advances in HIV

Thanks, web-books.com

Big news came out this past week in the fight against the spread of HIV.  For years, initiation of highly active antiretroviral therapy (HAART) has been determined by the sufficiency of a patient's immune system.  HAART initiation occurs after either CD4 counts (which is an indication of how well one's immune system is stocked) reach a low threshold or after an AIDS-related event, such as developing a strange disease that does not typically afflict folks with functioning immune systems.
The development of HAART was a game-changer in the AIDS epidemic, shifting the infection from a sure-fire killer to a chronic, manageable disease.  HAART involves some combination of daily medications, not without cost and side-effects, but its increasing availability has provided hope in the fight against AIDS worldwide.


An international study of HIV transmission has shown that those who are infected with HIV who take HAART before reaching that low threshold are 96% less likely to transmit HIV to their sexual partners.  The study, HPTN052, was a randomized control trial (in the realm of clinical science, that's about as good as they get) of over 1600 heterosexual couples from Brazil, sub-Saharan Africa, Thailand and the US scheduled to run through 2015.  However, results were so convincing that the researchers stopped the trial early on so they could get the information out.

This will likely alter treatment plans for those at risk of spreading HIV, and will almost certainly require an even higher ramping up of medication production and distribution worldwide.  But this brings us to the issue of HIV prevention: we already have effective, proven means of preventing its spread.  Condoms and needle-exchange programs (not to mention sexual abstinence) are actually sufficient to prevent the spread of HIV.  The crux of the matter lies in health behavior.  Why are those infected, as well as those at risk of infection, not partaking in the effective means of preventing disease spread?

Another issue is adherence to medication regimens.  As mentioned above, HAART is not without costs, both in terms of finances and side-effects.  Particularly in the US, even those at greatest risk of death by AIDS can be negligent of their medication regimens.  Even missing a few doses can lead to patients rapidly developing resistant strains of the virus.  What happens when we dramatically expand the treated population, particularly to patients who are taking their medications for ostensibly altruistic purposes?  This strategy will require not only an increased production of current medications, but also a wave of research into new medications capable of battling new resistant strains.

Regardless of the drawbacks, this is good news for the global fight against HIV.  Future research will be needed to determine the efficacy of this treatment for men who have sex with men, which were not targeted in this study, as well as in the realm of interventions to promote medication adherence in this broad population.