New study inspires hope of reduced transmission

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GABORONE – People infected with HIV have reduced risk of transmitting the virus to their sexual partners through the initiation of oral anti-retroviral, according to a study conducted by the HIV Prevention Trials Network (HPTN).

HPTN is a global partnership dedicated to reducing the transmission of HIV cutting-edge biomedical, behavioural and structural interventions.

A press statement from Botswana Harvard AIDS Institute Partnership for HIV Research and Education says the study, known as HPTN 052, is designed to evaluate whether immediate versus delayed use of ART by HIV-infected individuals would reduce transmission of HIV to their HIV-uninfected partners.

The release states that an independent data and safety monitoring board (DSMB) recommended that the results which were scheduled for release in 2015 be released as soon as possible and that the findings be shared with study participants and investigators.
The DSMB concluded that initiation of ART by HIV-infected individuals substantially protected their HIV-uninfected sexual partners from acquiring HIV infection with a 96 per cent reduction in risk of HIV transmission.

HPTN 052 is the first randomised clinical trial to show that treating an HIV-infected individual with ART can reduce the risk of sexual transmission.

Meanwhile, Dr Joseph Makhema, HPTN 052 site principal investigator and CEO of the Botswana Harvard AIDS Institute Partnership (BHP) said “this is excellent news.”

“The study was designed to evaluate key objectives: firstly, whether immediate versus delayed use of ART by HIV-infected individuals would reduce transmission of HIV to their HIV-uninfected partners thus benefiting the sexual partner. Secondly whether initiation of ART at different CD4 levels reduced AIDS defining illnesses and opportunistic infections and benefited the HIV-infected person.

“This is the first randomised clinical trial to definitively indicate that an HIV-infected individual can reduce sexual transmission of HIV to an uninfected partner by begging antiretroviral therapy sooner.

We at the BHP and the HPTN recognise the significant contribution that this study’s participants have made to further the progress in HIV treatment and prevention.
We are particularly grateful for the participation of couples from Botswana in this global initiative”, said Dr Makhema.

HPTN 052 began in April 2005 and enrolled 1 763 HIV-serodiscordant couples, the vast majority of which (97 per cent) were heterosexual.

The study was conducted in 13 sites in Botswana, Brazil, India, Kenya, Malawi, South Africa, Thailand, the United States of America and Zimbabwe.

In Botswana, 77 couples were enrolled. Among the 877 couples in the delayed ART group, 27 HIV transmissions occurred.

This was however in contrast with only one transmission that occurred in the immediate ART group.

This difference was highly statistically significant, the report states. The viruses transmitted in the 28 cases were confirmed to be linked by genetic analysis confirming that the source of the new infection came from the HIV-infected partner.

In the originally HIV-infected individuals themselves, 17 cases of extra pulmonary tuberculosis occurred in the delayed ART group compared with three cases in the immediate ART group also a statistically significant finding.

Throughout the study both groups received HIV-related care that included counseling on safe sex practices, free condoms, treatment of sexually transmitted infections, regular HIV testing and frequent evaluation and treatment for any complications related to HIV infections.

“Previous data about the potential value of anti-retrovirals in making HIV-infected individuals less infectious to their sexual partners came largely from observational and epidemiological studies,” said Professor Max Essex, chair of the BHP and Lasker Professor of Public Health at the Harvard School of Public Health.

He also said the HPTN 052 study provides compelling evidence for a new HIV prevention approach that links prevention and care efforts. BOPA