When doing the right thing is the best thing, Part 2
DURBAN, South Africa – In another example of what happens when proven HIV interventions are made appropriately available, final results from the Partners Demonstration Project presented here on Wednesday showed access to immediate HIV treatment for a person living with HIV, along with access to immediate prophylactic antiretroviral medicine for the person’s uninfected partner nearly eliminates risk of HIV transmission between partners. Underscoring the significance of the finding was the selection of couples deemed to be at particularly high risk. That included couples who were young, who had had sex without a condom in the last month, preferably childless, and among whom the male partner was not circumcised, Dr. Jared Baeten, who presented the results, said.
Carried out among more than a thousand couples in four communities in Kenya and Uganda, the study was open-label — couples knew the intervention they received, whether pre-exposure prophylactic antiretroviral medicine (PrEP), or HIV treatment, was the real thing. As the proven value of each intervention ethically pre-empted the use of a placebo, investigators used modeling based on relevant data to establish a contrasting scenario of infection rates without the interventions. Retention of study participants, at 86 percent of those enrolled after two years, was high. Adherence to the offered interventions, was as well, with tenofovir (the PrEP drug) detected in 82 percent of samples collected from uninfected participants (that’s in samples collected in 483 out of 587 clinic visits), and antiretroviral treatment suppressing the virus in 90 percent of those with HIV who initiated treatment. Rates of continued condomless sex, also were high, Dr. Baeten noted, as reflected in pregnancies among 18.5 percent of the participants.
Under such a scenario, Dr. Baeten said, an estimated 63 HIV transmissions could have been expected to take place over the course of the study. Instead, he said, researchers saw four — less, he added, “than the intervention arm of HPTN 052” (the trial that proved the preventive value of HIV treatment). Among the four individuals who became infected three had sample results showing no tenofovir, indicating at best inconsistent use of the PrEP intervention, and one had declined it from the start. In addition, one had separated from the HIV-infected partner, and now had a partner of unknown status, one was earning income through commercial sex work, one had multiple partners, and the partner of one was not on antiretroviral treatment.
The results indicated a “virtual elimination of incidence” when the interventions were adopted and adhered to, Baeten said. That meant, he added, that the approach of providing antiretroviral treatment immediately to infected partners, and until treatment succeeds in suppressing the virus, PrEP as a protective “bridge” intervention for the uninfected, is not only a feasible method of preventing transmission among couples, but is effective.