Study Demonstrates Early Initiation of Antiretrovirals FYI

Initiation of Antiretroviral Treatment Protects Uninfected Sexual

Partners from HIV Infection (HPT Study !"#$
%&' reduction in HIV transmission( accordin) to study conducted *y HIV
Prevention Trials et+or,- .en and +omen infected +it/ HIV reduced t/e
ris, of transmittin) t/e virus to t/eir sexual 0artners t/rou)/ initiation of oral
antiretroviral t/era0y (A1T$( accordin) to findin)s from a lar)e multinational
clinical study conducted *y t/e HIV Prevention Trials et+or, (HPT$( a
)lo*al 0artners/i0 dedicated to reducin) t/e transmission of HIV t/rou)/
cuttin)2ed)e *iomedical( *e/avioral( and structural interventions-
T/e study( ,no+n as HPT !"#( +as desi)ned to evaluate +/et/er
immediate versus delayed use of A1T *y HIV2infected individuals +ould
reduce transmission of HIV to t/eir HIV2uninfected 0artners and 0otentially
*enefit t/e HIV2infected individual as +ell- Findin)s from t/e study +ere
revie+ed *y an inde0endent Data and Safety .onitorin) 3oard (DS.3$-T/e
DS.3 recommended t/at t/e results *e released as soon as 0ossi*le and
t/at t/e findin)s *e s/ared +it/ study 0artici0ants and investi)ators- T/e
DS.3 concluded t/at initiation of A1T *y HIV2infected individuals
su*stantially 0rotected t/eir HIV2uninfected sexual 0artners from ac4uirin)
HIV infection( +it/ a %& 0ercent reduction in ris, of HIV transmission- HPT
!"# is t/e first randomi5ed clinical trial to s/o+ t/at treatin) an HIV2infected
individual +it/ A1T can reduce t/e ris, of sexual transmission of HIV to an
uninfected 0artner-
T/is is excellent ne+s( said Dr- .yron 6o/en( HPT !"# Princi0al Investi)ator
and Associate Vice 6/ancellor for 7lo*al Healt/ and Director of t/e Institute
of 7lo*al Healt/ and Infectious Diseases at t/e University of ort/ 6arolina
at 6/a0el Hill- T/e study +as desi)ned to evaluate t/e *enefit to t/e sexual
0artner as +ell as t/e *enefit to t/e HIV2infected 0erson- T/is is t/e first
randomi5ed clinical trial to definitively indicate t/at an HIV2infected
individual can reduce sexual transmission of HIV to an uninfected 0artner *y
*e)innin) antiretroviral t/era0y sooner- HPT !"# *e)an in A0ril #!!" and
enrolled 8(9&: HIV2serodiscordant cou0les (cou0les t/at /ave one mem*er
+/o is HIV2infected and t/e ot/er +/o is HIV2uninfected$( t/e vast ma;ority of
+/ic/ (%9 0ercent$ +ere /eterosexual- T/e study +as conducted at 8: sites
across Africa( Asia and t/e Americas- T/e HIV2infected 0erson +as re4uired
to /ave a 6D< cell count *et+een :"!2""! 0er cu*ic millimeter (cells=mm:$
at enrollment( and t/erefore did not re4uire HIV treatment for /is or /er o+n
/ealt/- 6ou0les +ere randomi5ed to one of t+o )rou0s- In one )rou0( t/e HIV
infected 0erson immediately *e)an ta,in) A1T (immediate A1T )rou0$- In
t/e ot/er )rou0( t/e HIV2infected 0erson *e)an A1T +/en /is or /er 6D< cell
count fell *elo+ #"! cells=mm or if /e=s/e develo0ed an AIDS2related illness
(t/e delayed A1T )rou0$-
T/rou)/out t/e study( *ot/ )rou0s received HIV2related care t/at included
counselin) on safe sex 0ractices( free condoms( treatment for sexually
transmitted infections( re)ular HIV testin)( and fre4uent evaluation and
treatment for any com0lications related to HIV
infection- Eac/ )rou0 received t/e same amount of care and counselin)-
Any HIV2uninfected 0erson +/o *ecame HIV2infected durin) t/e course of t/e
study +as referred to local services for a00ro0riate medical care and
treatment-
Amon) t/e >99 cou0les in t/e delayed A1T )rou0( #9 HIV transmissions
occurred- T/is +as in contrast to only one (8$ transmission t/at occurred in
t/e immediate A1T )rou0- T/is difference +as /i)/ly statistically si)nificant-
T/e viruses transmitted in t/ese #> cases +ere confirmed to *e lin,ed *y
)enetic analysis( confirmin) t/at t/e source of t/e ne+ infection +as t/e
0reviously HIV2infected 0artner- In t/e ori)inally HIV2infected individuals
t/emselves( 89 cases of extra0ulmonary tu*erculosis occurred in t/e
delayed A1T )rou0( com0ared +it/ t/ree (:$ cases in t/e immediate A1T
)rou0( also a statistically si)nificant findin)- T/ere +ere also #: deat/s
durin) t/e study- T/irteen (8:$ occurred in t/e delayed A1T )rou0 and 8! in
t/e immediate A1T )rou0- Study 0artici0ants and investi)ators are *ein)
informed of t/e results( and HIV2infected 0artici0ants in t/e delayed A1T
)rou0 +ill *e offered A1T- All study 0artici0ants +ill continue to *e follo+ed
for at least one more year- Previous data a*out t/e 0otential value of
antiretrovirals in ma,in) HIV2infected individuals less infectious to t/eir
sexual 0artners came lar)ely from o*servational and e0idemiolo)ical
studies( said IAID Director Ant/ony S- Fauci( .-D- T/is ne+ findin)
convincin)ly demonstrates t/at treatin) t/e infected individual and doin) so
sooner rat/er t/an later can /ave a ma;or im0act on reducin) HIV
transmission-
In India t/is study +as carried out at Y176A1E .edical 6entre(VHS in
6/ennai and at ational AIDS 1esearc/ Institute (A1I$ in Pune-
Dr--?umarasamy( 6/ief .edical @fficer of Y176A1E and t/e study Princi0al
Investi)ator for t/e 6/ennai site mentioned t/at t/is landmar, trial clearly
states t/at Antiretroviral t/era0y s/ould *e initiated early in Indian HIV
infected 0ersons-