HPTN 052 - Treating HIV to Prevent HIV

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SAN ANSELMO, CA - NOVEMBER 23: Bottles of antiretroviral drug Truvada are displayed at Jack's Pharmacy on November 23, 2010 in San Anselmo, California. A study published by the New England Journal of Medicine showed that men who took the daily antiretroviral pill Truvada significantly reduced their risk of contracting HIV. (Photo Illustration by Justin Sullivan/Getty Images). Justin Sullivan/Getty Images News/Getty Images

Study 52 from the HIV Prevention Trials Network (HPTN 052) may turn out to be one of the most important studies in understanding the treatment and prevention of HIV. The study, which began in 2005 as a way to determine the effectiveness and importance of early treatment for HIV has completely revolutionized how doctors and scientists understand the role of treatment in prevention.

At the start of it's 10 year process, HPTN 052 enrolled more than 1700 sero-discordant (predominantly heterosexual) couples around the globe.

Half of those couples were randomized so that the HIV-positive partner would start treatment ASAP. The other half were randomized to what was then the standard of care - waiting for the infected partner's health to decline, their CD4 cell counts to drop, or for them to develop an AIDS defining illness.

Over the course of the decade long study, the researchers found a number of important results. However, there are two results that are particularly noteworthy.

Starting Treatment Early Has Long-Term Health Benefits For People with HIV

The first result is that people who started HIV treatment sooner after infections had significantly improved long-term health. They were also much easier to treat. They were able to achieve viral suppression much sooner after treatment initiation than individuals who started with higher viral loads. They were significantly less likely to develop drug resistant infections.

Most critically, they were less likely to fail treatment.

Starting Treatment Early Protects Sexual Partners From Infection

The other big result from HPTN 052 is that treatment as prevention works. Over the course of the study, sexual partners of individuals who started HIV treatment early were 93 percent less likely to become infected with HIV themselves.

Furthermore, data suggested that the eight HIV transmissions that did occur in that group generally occurred either before treatment had suppressed a partner's viral load or when their viral load had rebounded for some reason -- such as inconsistent use of therapy.

HPTN 052 - The Takeaway

There are two main takeaways from this decade long study of treatment and prevention. The first is that it's a good idea for anyone with HIV to start treatment early. For most people, the possible side-effects associated with treatment are likely less problematic than missing out on the benefits of early viral suppression. The second is that it seems like people whose sexual partners are HIV positive are relatively safe from infection when their partners are both taking their medication properly and consistently virally suppressed. While condoms and other forms of safe sex are never a bad idea, sex with someone with an undetectable viral load is unlikely to lead to infection with HIV.

Sources:

M Cohen, et al. Final results of the HPTN 052 randomized controlled trial: antiretroviral therapy prevents HIV transmission. Program number MOAC0106LB, Track C.

SH Eshleman, et al. Treatment as prevention: characterization of partner infections in the HIV Prevention Trials Network 052 trial. Program number MOAC0106LB, Track C.

J Fogel, et al. Identification of factors associated with viral suppression and treatment failure when antiretroviral therapy is used for HIV prevention: results from the HIV Prevention Trials Network (HPTN 052) trial. Program number MOPEC417, Track C.

D Sabin, et al. Analysis of HIV drug resistance in adults receiving early antiretroviral treatment for HIV prevention: results from the HIV Prevention Trials Network (HPTN 052) trial. Program number TUPEB285, Track B.

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