Those whose antiretroviral treatment was delayed never recovered the immune cell counts achieved by those who initiated treatment earlier
VANCOUVER, Canada – The first findings from the original “game-changing” HIV treatment study that Science magazine hailed as its “Breakthrough of the Year,” came four years ago, after trial monitors determined they were too good to keep under wraps any longer.
HPTN 052, which, across 13 sites in nine countries, showed that antiretroviral treatment was not only good for the health of people living with HIV, but good for the health of their uninfected partners as well, lowering transmission risks by 96 percent. The findings knocked down the perceived divide between treating and preventing HIV, laid the groundwork for ambitious acceleration of treatment access, and added evidence to talk of ending AIDS as a global health threat.
The end of the trial, which began enrolling patients in 2005, however, didn’t come until this year, and on Monday afternoon, not unlike an author well known for one work delivering a long awaited sequel, Dr. Myron Cohen, lead investigator of the study, told the story of what has happened to the couples who remained in the study and delivered the final validation that antiretroviral treatment can reduce transmission risks in couples among whom one partner is infected and the other is not.
Their story had left off in 2011, when all were told of the trial results, with the offer of antiretroviral treatment to those in the control arm of the study who had not been receiving it. Of them, 16 percent declined the offer, primarily because they saw no urgency, Cohen said. Those who did begin after being in the delayed group never recovered the immune cell, or CD4 count achieved by those who had started treatment earlier.
By 2015, 87 percent of the participants remained in the setting, but only 66 percent of the couples had stayed together. Among those who stayed together, some uninfected partners became infected through sex outside of their relationships. With all that accounted for, by the time the trial ended this year, eight uninfected people caught HIV from a partner who was receiving antiretroviral treatment in the study. Of those, four transmissions, including the one transmission prior to 2011, were contracted early in the infected partners’ treatment. Four occurred after treatment had failed. None of the treatment failures were due to drug resistance, Cohen said.
Nearly all of the couples enrolled in the study — 97 percent — were heterosexual, Cohen said, but that, he noted, didn’t mean they didn’t engage in anal intercourse. “We see no reason why it should be different,” he added.
Four years after the first findings, Cohen, and Dr. Susan Eshleman, who presented the findings on the transmissions that occurred, effectiveness of antiretroviral treatment in preventing HIV transmission from infected to uninfected partners proved durable.
“For those who have followed the saga of HPTN 052, this is the end,” Cohen said.
It was, of course, also a beginning, or at least a continuation of an ongoing story that has yet to end. The affirming final presentation of HPTN 052 nearly overlapped Monday with the findings from START, which validated, in turn, a stance that Cohen has taken at every opportunity (i.e. here) in the years since 2011:
- That “We need to separate financial and logistical concerns from what is the best medical advice.”
- That nobody could say that depleting one’s immune cell count is a good idea;
- That everyone tested should start treatment.