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And the band played on, for there was good news to share.
May 12, 2011 12:34 PM   Subscribe

An NIH clinical trial has shown that early treatment of HIV with antiretroviral drugs reduces the odds of the virus being transmitted to an uninfected sexual partner by 96%, with only one new HIV case recorded out of the 1,763 couples participating in the trial.
posted by schmod (31 comments total) 8 users marked this as a favorite

 
reduced transmission rates between partners having protected or unprotected sex? Either way, this is a significant finding, but the scope of the implications will be much larger if this reduces transmission without safer sex practices…
posted by LMGM at 12:40 PM on May 12, 2011


For the couples to participate, the partner had to be HIV-free at the start of the study. Almost all the 1,763 couples were heterosexual (97 percent). The infected partner was male in 890 cases and female in 873.

is there more info? Were they having unprotected intercourse? Did they tell the truth? While this is great news, I'd like a lot more information.

The study recruitment site says they had to have anal or vagina sex at least 3 times a month, but there's no way to tell how compliant the couples were during the study.

Condoms--you can see them. Your bf telling you he's taking his meds-- need to be able to tell for sure.
posted by Ideefixe at 12:43 PM on May 12, 2011


Related, from Al Jazeera: Experimental AIDS vaccine 'works in monkeys'
posted by reductiondesign at 12:45 PM on May 12, 2011


And the very first comment says:
HIV does not cause AIDs of course. My guess is a mutated form of syphilis is the cause. Look it up. There is no evidence whatsoever that HIV causes AIDs. The phony little virus appeared to co-exist with the disease, but now that evidence is failing.
sigh
posted by jcreigh at 12:47 PM on May 12, 2011 [5 favorites]


Hey, neat!

That said, such a study would raise a lot of ethical red flags, wouldn't it?
posted by Sys Rq at 12:47 PM on May 12, 2011


Animal trials are great but don't get your hopes up too much. You'd be amazed how many things work in animals which fail partially or completely in humans. Granted, a primate trial is more suggestive than a trial on mice but still.
posted by Justinian at 12:48 PM on May 12, 2011


I've got to go teach but here are the publications this study has produced so far

"That said, such a study would raise a lot of ethical red flags, wouldn't it?"

The authors would have to address those concerns at clinicaltrials.gov

As always if anyone needs access to papers Memail me an email address for me to send them to so that you can better contribute to this academic discussion, which we are currently having
posted by Blasdelb at 12:50 PM on May 12, 2011 [1 favorite]


That said, such a study would raise a lot of ethical red flags, wouldn't it?

The thing is, they do studies like this all the time. But I always wonder about it. Where do they find these people? It always blows my mind.

---

That said there's always a risk that a partial solution will just increase people's sexual activity. Like if you prevent AIDS with a 96% success rate, people will just have 20 times as much sex.
posted by delmoi at 12:51 PM on May 12, 2011


I guess you might file this under 'nitpick', but I don't think it's a nitpick:

From the post text:
...reduces the odds of the virus being transmitted to an uninfected sexual partner by 96%...

From the article:
...cut the risk of HIV transmission to the uninfected partner by 96 percent...

Those are different things. odds = probability / (1 - probability)
posted by gurple at 12:54 PM on May 12, 2011


None of the conditions for inclusion or exclusion from the study mention safer sex practices.

I don't think that this makes the study meaningless. If they put no conditions on the safer sex practices of the couple, then they have a sample that is closer to representative of the general population of HIV discordant couples. Then they can compare their results to previous studies of rates of transmission in HIV discordant couples.

This study seems to be about reducing the rate of transmission, not the absolute rate of transmission depending on what the couples practice. If there is a reduction in the risk, then that will show in couples that are practicing safer sex and those who are not.
posted by Kutsuwamushi at 12:57 PM on May 12, 2011


There's not a lot to go on here, few things that we can glean from the very limited information available:

(1) This study was halted before its scheduled completion date (2015), because it showed a statistically significant impact on HIV transmission. None of these results have been published in peer-reviewed literature. So it not quite correct to say that a clinical trial "has shown" anything - merely that the preliminary results seem to indicate it.

(2) Participants were randomized to either (a) receive HIV primary care and antiretroviral treatment (ART) immediately, or (b) receive HIV primary care, but only receive treatment after CD4 counts fell below 250 cells/mm³ or an AIDS-related event, such as Pneumocystis pneumonia. So there is no "no treatment" arm (if there were it would indeed raise some ethical flags) - there is an immediate and a deferred treatment arm.

(3) "Both groups received HIV-related care that included counseling on safe sex practices, free condoms, treatment for sexually transmitted infections, regular HIV testing, and frequent evaluation and treatment for any complications related to HIV infection. Each group received the same amount of care and counseling." So we can assume (though we can't know for sure without looking at the data) that condom use, etc., was the same in both groups.
posted by googly at 12:59 PM on May 12, 2011 [3 favorites]


The thing is, they do studies like this all the time. But I always wonder about it. Where do they find these people? It always blows my mind.

They found them in Botswana, Brazil, India, Kenya, Malawi, South Africa, Thailand, the United States and Zimbabwe - e.g., almost all countries with extraordinarily high rates of HIV and low access to treatment of any kind. So participating in a study where everyone is guaranteed HIV primary care and (immediate or deferred) ART is not at all surprising.
posted by googly at 1:02 PM on May 12, 2011 [1 favorite]


Does anyone know if the findings are robust to male-male couples, and not just heterosexual pairings? The news article says "Almost all the 1,763 couples were heterosexual (97 percent). The infected partner was male in 890 cases and female in 873."

(I ask because anal receptive intercourse has a considerably higher per-act probability of transmission compared both to anal insertive, vaginal insertive and vaginal receptive intercourse. See here starting top of page 7). It would be useful to know if this intervention has generic applicability, or is only suitable for areas with high rates of heterosexual transmission).
posted by scunning at 1:12 PM on May 12, 2011 [1 favorite]


It's also important to know that the study focused almost exclusively on heterosexual couples and excluded IV drug users. It also only included HIV-infected individuals who hadn't shown signs of AIDS when they entered the study. Finally, as scunning questions, they did take couples who engaged in both vaginal and anal sex (per clinicaltrials.gov), though I'm assuming that anal sex was probably underrepresented since most of the couples were heterosexual.

It's huge news to be sure (though realistically, I'm not sure this result is all that unexpected), but those are some significant limitations on the results. Knowing how well this outcome can be generalized to homosexual partners and those showing signs of an AIDS-defining illness would be pretty important.

Keep in mind though that a good deal of HIV transmission in Africa is through heterosexual sexual activity, so this study's results are encouraging even if we don't know how well they hold up for gay couples.
posted by zachlipton at 1:21 PM on May 12, 2011


Where do they find these people? It always blows my mind.


I've volunteered for HIV vaccine research before, what's blowing your mind? They don't ask you to change your sexual behavior in any way, and encourage safe sex practices for those patients that aren't currently playing safe. You might end up with a lifelong benefit, you definitely will have helped out your fellow man even if a particular drug is a failure, and you are no more at risk than if you'd just continued to live your sexual life as before.

If there's a downside to having participated back in the early days, it's that I grew enough antibodies to trigger the cheap HIV tests and have to get a secondary test for actual virus every time I go in now, and I can't participate in the latest trials.
posted by No1UKnow at 1:27 PM on May 12, 2011 [3 favorites]


Wouldn't the "result" of this be just as likely that an uninfected partner of an HIV positive person is very, extremely, or almost positively likely to always engage in protected sex? I can't really see how this is indicative of any success of a antiretroviral drug.... Or am I missing something?
posted by Debaser626 at 1:43 PM on May 12, 2011


I was an HIV vaccine guinea pig a couple years ago.

They were mostly recruiting from the local gay community. I got asked a lot (a lot) of sexual questions, but when it came to my sexuality, I don't think they were allowed to flat out ask it so I was asked to pick up a certain pen whether "you have sex with women (places yellow pen on table) or you have sex with men (places pink pen on table)". Then I got informed of all the risks involved. Like I might return a false positive for HIV tests in the future. (also I think I vaguely remember something about the minor risk of the vaccine altering my DNA and turning me into some kind of mutant/chimera.) The actual injection was pretty interesting. I was in a special group that was not only testing the vaccine, but also the method of administering it: an experimental electroporator that had been used on about a dozen humans before me. Imagine a device with 6 long needles sticking out of it that is inserted into your arm, then sends a strong electric current through your body. It felt kind of like being punched by a very tiny man from inside my arm. I got paid a little bit, and it was nice to be part of something that could potentially save a lot of people.

Last week I got a call from an old area code. I usually don't answer unknown numbers on my cell, but I picked it up. "Just wanted to let you know you're being unblinded. You had the placebo. You're safe to donate blood and stuff." So, no mutant powers.
posted by MrFTBN at 1:45 PM on May 12, 2011 [7 favorites]


Wouldn't the "result" of this be just as likely that an uninfected partner of an HIV positive person is very, extremely, or almost positively likely to always engage in protected sex? I can't really see how this is indicative of any success of a antiretroviral drug.... Or am I missing something?

That really depends on a lot of things. It's quite possible that safer sex resources are not widely available where the study is taking place. See this comment:

They found them in Botswana, Brazil, India, Kenya, Malawi, South Africa, Thailand, the United States and Zimbabwe - e.g., almost all countries with extraordinarily high rates of HIV and low access to treatment of any kind.
posted by entropone at 1:56 PM on May 12, 2011


Wouldn't the "result" of this be just as likely that an uninfected partner of an HIV positive person is very, extremely, or almost positively likely to always engage in protected sex? I can't really see how this is indicative of any success of a antiretroviral drug.... Or am I missing something?

Starting treatment early (i.e., as soon as the status is know, rather than waiting for T-cells to drop below X) seems to keep the virus from replicating hugely. This has two benefits: the infected person stays healthier longer, and their sex partners run a lower risk of becoming infected when (not if) unprotected sex is being had.

Assuming that couples where one person is infected and the other is not will always have protected sex is unrealistic. This is especially true in parts of the world where the woman does not have enough power in the relationship (or society) to make her partner wear a condom.
posted by rtha at 2:01 PM on May 12, 2011


Wouldn't the "result" of this be just as likely that an uninfected partner of an HIV positive person is very, extremely, or almost positively likely to always engage in protected sex? I can't really see how this is indicative of any success of a antiretroviral drug.... Or am I missing something?

The study appears to have controlled for this. Everyone in the study was part of a couple in which one person was infected with HIV and the other wasn't. The infected partners of one arm received immediate therapy; the others received deferred therapy. Judging by what we can see of the protocol, there is no reason to expect that, as a group, the uninfected partners in one arm would be more or less likely to engage in protected sex. So the observed difference in the arms (27 of 28 infections of previously uninfected partners occurred in the deferred arm) are likely to be due to the ART.
posted by googly at 2:02 PM on May 12, 2011


Granted, a primate trial is more suggestive than a trial on mice but still.

It really depends a lot on what you're talking about. Unfortunately in the case of HIV/AIDS, a lot of the research on primates isn't very suggestive at all. There are different strains of HIV, and in the case of chimpanzees at least, the results are often confusing. Some strains infect the chimps but don't cause AIDS, some cause AIDS only in previously infected chimps, and some are easily fought off by the chimps' immune systems. Sometimes the same strain affects individual chimps differently.

This isn't even getting into the ethical or practical dilemma facing this area of research; the first-hand accounts of researchers watching a chimp infected with AIDS by their own hand waste away are truly heartbreaking. In addition, a single chimp costs quite a lot, and to get statistically significant results is unfortunately out of reach for many labs.

If you'd like more specifics, the book "Almost Chimpanzee" by John Cohen gives a decent overview of the problems facing the field.
posted by TheMidnightHobo at 4:22 PM on May 12, 2011


HIV does not cause AIDs of course. My guess is a mutated form of syphilis is the cause. Look it up.

GOOGLE SYPHILITIC RON PAUL!
posted by formless at 4:44 PM on May 12, 2011 [1 favorite]


This initiative, while positive, does raise some interesting issues because it surrounds an intervention undergone by the patient, but for the benefit of someone else.

Antiretroviral treatment has tons of side effects, increased risk of heart disease, liver problems, weight gain, facial abnormalities. While these are vastly decreased with the newer generation, they aren't benign... Which is why most HIV docs I know wait until the T cell count falls below a certain level. While it's fair to encourage your patient to take a treatment for his or her own benefit, I'm not sure how kosher it is to advocate them to assume risks of treatment for benefit of a third party.

You know, do no harm and all that jazz.
posted by cacofonie at 5:53 PM on May 12, 2011 [1 favorite]


That said, such a study would raise a lot of ethical red flags, wouldn't it?

You're allowed to deliberately infect yourself for medical science and it's been done before. Infecting other people on purpose is a different matter.

But giving people who are already in harms way, and who aren't planning on getting out of harms way, a prophylactic treatment to asses it's efficacy is pretty much OK. Placebos are almost never used with terminal diseases unless it's "current best treatment plus placebo" or "current best treatment plus compound X".
posted by Kid Charlemagne at 7:02 PM on May 12, 2011


Does the post imply that if you do nothing to prevent it, your chances of getting HIV from an infected partner is about 25/1,763?

That's a lot lower than my high school health class sort of implied.
posted by tylerkaraszewski at 8:25 PM on May 12, 2011


Where do they find these people? It always blows my mind.

AC Transit. There were ads on the bus a couple of years back recruiting for a HIV vaccine trial. (Not this one, I'm pretty sure.)
posted by hoyland at 9:00 PM on May 12, 2011


This isn't a vaccine study, anyway. It's about early treatment for infection in one person helping provide prophylaxis for their uninfected partner. It's a great thing to learn, but it's absolutely not a vaccine.
posted by hippybear at 9:11 PM on May 12, 2011


> And the very first comment says:
HIV does not cause AIDs of course. My guess is a mutated form of syphilis is the cause. Look it up. There is no evidence whatsoever that HIV causes AIDs. The phony little virus appeared to co-exist with the disease, but now that evidence is failing.


I'm just realizing what fertile ground AIDS is for conspiracy theorists.

Had a long conversation at a party the other night, after everyone'd had a few whiskey sours, with a handsome, charming, well-educated gay gentleman, libertarian, in his late twenties or early thirties, who was intractably convinced – and intended to convince everyone else there – that the US government, via the WHO, had deliberately created and infected gays with AIDS to eliminate "undesirables" in the population. He could rattle off dates, specific quotes, studies, veritable mountains of circumstantial evidence. The spiel was probably twenty solid minutes long altogether. But where they fucked up, he told me, was they forgot about the bisexuals. And now it was out of control. Everybody was getting it. It trumped any 9/11 Was An Inside Jobber I've ever talked to.

It later struck me how terrifying it must feel every day to live under a government you believe is still covering up an attempted extermination of the community you're a part of, and that is a part of you. The fact that theories like this spread, and take such deep hold, I think shows how colossal and difficult to grasp AIDS still is as a social and a biological epidemic. That even the grotesque joke of going to the polls to elect the next person to oversee the cover-up of your attempted genocide is still more comforting a thought than this terrible cruel disease simply grinding us up without cause or meaning.
posted by churl at 10:07 PM on May 12, 2011 [2 favorites]



Does the post imply that if you do nothing to prevent it, your chances of getting HIV from an infected partner is about 25/1,763?

That's a lot lower than my high school health class sort of implied.


Yeah, the chance of transmission from a single exposure is actually pretty low, around 0.5-1.5% for anal intercourse and 0.1-0.3% for penile-vaginal intercourse.
posted by jcreigh at 10:10 PM on May 12, 2011 [1 favorite]


Wouldn't the "result" of this be just as likely that an uninfected partner of an HIV positive person is very, extremely, or almost positively likely to always engage in protected sex? I can't really see how this is indicative of any success of a antiretroviral drug.... Or am I missing something?

It doesn't really work like that in practice, and the current hype about using treatment to prevent new infections exacerbates this situation, so it better damn well work given all the press it's had.

Think of it this way:

A straight couple is having sex. Both partners know that they're both fertile, and neither wants a child. Are they "very, extremely, or almost positively likely to always engage in protected sex"? No, people have varying degrees of risk that they're willing to take in the hunt for an orgasm.

Now she's on birth control. (Let's say this is analogous to the HIV+ partner going on treatment.) What are the odds of using protection now?
posted by heatherann at 5:17 AM on May 13, 2011


In other HIV news, Timothy Ray Brown may be the first person to have been cured of HIV. He received a bone marrow transplant from a donor with a specific mutation in the CCR5 coreceptor which prevents the virus from entering T cells.
posted by euphorb at 8:18 AM on May 13, 2011


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