2011: breakthrough year for HIV
28 December 2011, 11:46
The journal Science has chosen the HPTN 052 clinical trial an
international HIV prevention trial sponsored by the National Institute
of Allergy and Infectious Diseases (NIAID), part of the National
Institutes of Health, as the 2011 Breakthrough of the Year.
The study found that if HIV-infected heterosexual individuals
begin taking antiretroviral medicines when their immune systems are
relatively healthy as opposed to delaying therapy until the disease has
advanced, they are 96% less likely to transmit the virus to their
uninfected partners. Findings from the trial, first announced in May,
were published in the New England Journal of Medicine.
The complete top 10 list of 2011 scientific breakthroughs appears in the December 23, 2011, issue of Science.
Antiretrovirals treat and prevent HIV
"The HPTN 052 study convincingly demonstrated that antiretroviral medications
can not only treat but also prevent the transmission of HIV infection
among heterosexual individuals," said NIAID Director Anthony S. Fauci,
"We are pleased that Science recognised the extraordinary public health
significance of these study results. This recognition also is a credit
to the hard work and dedication of the HPTN 052 researchers and the more
than 3 000 study participants who selflessly gave their time and energy
to make such a significant contribution to the fight against HIV/Aids."
Led by study chair Myron Cohen, MD, director of the Institute for
Global Health and Infectious Diseases at the University of North
Carolina at Chapel Hill, HPTN 052 began in 2005 and enrolled 1 763
heterosexual couples in Botswana, Brazil, India, Kenya, Malawi, South
Africa, Thailand, the United States and Zimbabwe.
Couples randomly assigned
Each couple included one partner with HIV infection. The investigators
randomly assigned each couple to either one of two study groups. In the
first group, the HIV-infected partner immediately began taking a
combination of three antiretroviral drugs.
The participants infected with HIV were extensively counselled on the
need to consistently take the medications as directed. Outstanding
compliance resulted in the nearly complete suppression of HIV in the
blood (viral load) of the treated study participants in group one.
In the second group (the deferred group), the HIV-infected partners
began antiretroviral therapy when their CD4+ T-cell levels - a key
measure of immune system
health - well below 250 cells per cubic millimetre or an Aids-related
event occurred. The HIV-infected participants also were counselled on
the need to strictly adhere to the treatment regimen.
The study was slated to end in 2015, but an interim data review in May
by an independent data and safety monitoring board (DSMB) found that of
the total 28 cases of HIV infection among the previously uninfected
partners, only one case occurred among those couples where the
HIV-infected partner began immediate antiretroviral therapy. The DSMB,
therefore, called for immediate public release of the study's findings.
Combine methods to fight HIV/Aids
The magnitude of protection against HIV infection demonstrated in HPTN
052 has made the successful strategy of the clinical trial a key
component of public health policies recently discussed by federal
officials and others saying that achieving an end to the HIV/Aids
pandemic is now feasible with additional research and implementation
"On its own, treatment as prevention is not going to solve the global
HIV/Aids problem," said Dr Fauci. "Yet when used in combination with
other HIV prevention methods - such as knowing one's HIV status through
routine testing, proper and consistent condom
use, behavioural modification, needle and syringe exchange programs for
injection drug users, voluntary, medically supervised adult male
circumcision, preventing mother-to-child transmission, and, under some
circumstances, antiretroviral use among HIV-negative individuals - we
now have a remarkable collection of public health tools that can make a
significant impact on the HIV/Aids pandemic."
"Scale-up of these proven prevention methods combined with continued
research toward a preventive HIV vaccine and female-controlled HIV
prevention tools places us on a path to achieving something previously
unimaginable: an Aids-free generation," Dr Fauci added.