July 18th, 2011
12:52 PM ET

More studies show PrEP prevents HIV infection

The evidence is mounting.  Another study has found that PrEP - pre-exposure prophylaxis - is relatively safe and can prevent HIV transmission in couples where one partner is already infected with the virus.

The data from the study, called the HPTN 052 trial, released Monday in the New England Journal of Medicine  at the International AIDS Society Conference in Rome.  Researchers enrolled nearly 1,800 couples in Botswana, Kenya, Malawi, South Africa, Zimbabwe, Brazil, India, Thailand and the United States.

Fifty-four percent of the couples were from Africa; half of the infected partners were men. Those infected, with CD4 counts between 350 and 550, were randomly broken into two groups. In one group, the infected partner received antiretroviral drugs when they were enrolled. In the other, therapy was delayed until after their CD4 count fell below 250, or they suffered an AIDS related illness.

CD4, or T-Cells are a type of white blood cell that helps the body fight infections like viruses and bacteria. The higher your count, the stronger your immune system which helps reduce complications of HIV. When the CD4 count falls below 200 a person has AIDS.

Researchers found for those who got antiretroviral therapy (ART) early, the rate of transmission dropped by 96% compared with those who were treated later. HIV transmission occurred in just 39 people. Twenty-eight of those were directly linked to the HIV-infected partner. Of that 28, only one was from the group that got early treatment. HIV patients that got early therapy also had less HIV-related illness.

"HPTN 052 demonstrated that early initiation of ART by the infected partner in heterosexual couples, where one partner is HIV-infected and the other not, is highly effective in decreasing transmission of HIV to the uninfected partner," said Dr. Anthony Fauci, director, National Institute of Allergy and Infectious Diseases  at the National Institutes of Health. "With these recent advances, we now have an unprecedented opportunity, based on solid scientific data, to control and ultimately end the AIDS pandemic. Of course, global implementation of HIV interventions, including the scale-up of the delivery of ART, must be accelerated, and this will be costly. A truly global commitment is essential. In this regard, major investments in implementation now will save even greater expenditures in the future; and in the meantime, countless lives will be saved."

The drugs used included Combivir, a combination of zidovudine and lamivudine; lopinavir and ritonavir or Kaletra–also known as Aluvia; and the combination tenofovir and emitricitabine whose brand name is Truvada. Last week, two different African studies, one of uninfected heterosexual men and women in Botswana, and the other of heterosexual couples in Kenya and Uganda, found Truvada significantly reduced the risk of transmission in study participants.

In the HPTN study, 82% of the transmissions occurred in Africa. Researchers say more frequent sexual activity and less condom use could be a reason for increased transmission there. Study investigators also saw higher viral loads in HIV patients in sub-Saharan Africa versus patients from developed countries.

Adverse events most often reported included infections, gastrointestinal problems, nervous system disorders and psychiatric issues. Some patients were found to have pulmonary tuberculosis; the majority of those cases were seen in India. More adverse events were seen in patients that got the drugs early. Study authors say the reason is unclear and more follow-up is necessary.

Researchers admit the study, funded by NIAID, is not without limitations. They say the couples were "stable" and possibly not representative of the general population. They were also counseled and given condoms, which authors say could have contributed to the low rate of infection.

New data from the iPrEx study is also being released this week at international AIDS meeting. In iPrEx, a trial that spanned four continents, daily PrEP with Truvada reduced HIV infections in men who have sex with men, or MSM. It was one of the largest studies ever conducted and the first in Asia or Africa that focused on MSM. Eleven new analyses will be presented.

"These new analyses confirm the safety and efficacy of PrEP in MSM and strengthen our belief that PrEP is an important HIV prevention tool with the potential to prevent significant number s of new HIV infections," said iPrEx Protocol Chair Dr. Robert Grant, Gladstone Institutes and the University of California at San Francisco. "When we viewed along with the Partners PrEP and TD2 data in heterosexual men and women, these findings make a compelling case that providing broad access to PrEP could reduce the human and financial cost of the epidemic significantly."

soundoff (32 Responses)
  1. BC

    The best practical way to prevent HIV transmission is to use condoms every single time during every kind of act. It's a no-brainer, really. If she tells you she's on the Pill, strap on a rubber anyway. Oral pleasures? Strap it on and use it. It's better than HIV and every other STD. If you choose not to use it, don't cry when you test positive and don't expect taxpayers to pay for your treatments. HIV is 100% preventable.

    July 18, 2011 at 18:31 | Report abuse | Reply
    • JohnWayne

      You must be quite a dumb azz for stating that HIV is 100% preventable. Condoms are NOT 100% effective, you duck.

      July 18, 2011 at 21:23 | Report abuse |
    • sarah

      ... so what about people who don't have access to condoms or have never received education on prevention methods??

      July 18, 2011 at 23:09 | Report abuse |
    • Kieran

      @sarah you know there are plenty of organizations that will give people that education for free, as well as the condoms? Just because people don't make the effort to learn or to go get those free condoms doesn't mean they're excused from their behavior. Heck, even if you're a college kid your school's clinic usually has free condoms for students.

      July 19, 2011 at 13:32 | Report abuse |
    • myhepcdiary

      Not a hundred percent preventable if you got it from blood transfusions back in the eighties...or if you are born to an infected mother...or if you are a nurse and an HIV positive patient vomits bloody puke into your eyes (true story). No matter how you got it, you don't deserve something like this. Quit being ignorant.

      July 28, 2011 at 19:40 | Report abuse |
  2. michael smith

    Hey, it's just like Jello! Find new ways to use an old product and make even more cash cows! Mooooo. I mean, why bother finding a cure when you can milk society forever?

    Right Pharma?

    July 18, 2011 at 19:39 | Report abuse | Reply
    • Slim

      Michael, there already is a cure. It's called self-control. Why blame others for your lack of restraint? Be a man. Take responsibility for your actions.

      July 18, 2011 at 21:19 | Report abuse |
    • Brad

      Slim, what is your reasoning? Someone who is HIV+ can cure themselves with self control?

      July 19, 2011 at 03:53 | Report abuse |
    • Slim

      Brad. Your intentional misunderstanding is humerous. Thanks for the chuckle.

      July 19, 2011 at 19:42 | Report abuse |
    • Sarah

      Wow. Do you realize how hard it is to treat HIV? Don't blame the pharmaceutical companies for this one. HIV mutates so quickly that it is essentially impossible to cure it with the medicine currently used. As a molecular biologist, I can tell you that big pharma is not to blame for this one. While I agree they do some underhanded things to make money, this truly isn't one of them. HIV is very tricky and complex. Additionally viral infections are much harder to cure than bacterial ones in the sense that viruses aren't technically alive in the way that bacteria are. Please keep your ignorant opinions to yourself until you have done the proper research.

      August 10, 2011 at 16:05 | Report abuse |
  3. Slim

    Studies also show that abstinence prevents HIV more effectively than drugs.

    July 18, 2011 at 21:00 | Report abuse | Reply
    • Reisk

      Studies also show that 'quality of life' is a big part of this thing called 'life', and that most people find your suggestion of abstinence to be unhelpful.

      And if you want to preach to me that I can have a happy and fulfilled life while enjoying your abstinence, or that failure of abstinence is responsible for the moral corruption of our society, then please allow me to preach to you the joys of being thrown under a bus.

      July 18, 2011 at 22:31 | Report abuse |
    • Jorge

      No but hell no slim, to live like that, you might as well cut it off. Back in the eighties I took an STD seminar, and grilled the doctors on everything from cold sores to Hep C as well as contagion rates, best practices and such. After that, I traveled all around the Caribbean basin and went through rubbers like wind goes through a sieve, boy did I have fun, never caught so much as a case of the crabs. You enjoy yourself living like a medieval monk.

      July 19, 2011 at 08:43 | Report abuse |
    • Jeff

      Abstinence is no more realistic than expecting someone to spend their lives locked away in an antiseptic dungeon to avoid cancer-causing carcinogens.

      July 19, 2011 at 10:34 | Report abuse |
    • Slim
      July 20, 2011 at 22:20 | Report abuse |
  4. Alexandra

    This is really inspiring. I've just met the most amazing man who is HIV , and I wondered how I would get over that fact to be with him. Even though I knew I would always use a condom, I was worried about being intimate with him. This news makes me feel much more secure about being with him. He is someone I could see myself falling in love with...

    July 18, 2011 at 22:39 | Report abuse | Reply
  5. fernace

    I'm glad to hear of these advances to curb the spread of HIV-AIDS. Thanks to BC for manning up about condoms. As a single woman, I refuse to date a man who refuses to use condoms. My motto is, if you "can't feel anything" now, imagine how much less you'll feel 6ft. under! It's very irresponsible to discount the immense help this inexpensive product has been to the promotion of safe s. e. x., which is a natural human drive & abstinence is not! It's protection rate against pregnancy or STD's is roughly 92-97%! For those of us who insist on being s.e.x.ually active & chose not to live like monks, it is a lifesaver & a great investment!!

    July 18, 2011 at 23:52 | Report abuse | Reply
    • Alley Health

      Awesome. Wish I could get the students I work with to follow the same practices!

      July 19, 2011 at 10:40 | Report abuse |
    • Maya

      Your figures are a bit off. 86% pregnancy prevention is the norm for condoms. As far as STD prevention, it depends on the STD. Certain diseases, such as HPV and genital herpes (both of which transmit via skin contact), are harder to prevent with condoms.

      July 19, 2011 at 11:14 | Report abuse |
  6. D

    Editor should double check – the article describes treatment as prevention, not PrEp. Treatment as prevention gives drugs to those already infected to prevent onward transmission to others; PrEP gives drugs to HIV- people to prevent themselves from becoming infected.

    July 18, 2011 at 23:55 | Report abuse | Reply
  7. Coach Lew

    It's a shame that Alzheimer's don't get the same amount of research money that HIV/AIDS receives from our government. There was $8 Billion spent on AIDS research last year as compared to $432 million spent on Alzheimer's research can anyone tell me if that is fair?

    July 18, 2011 at 23:56 | Report abuse | Reply
    • Slim

      It is not fair.

      July 19, 2011 at 19:55 | Report abuse |
  8. Coach Lew

    Where are all of you Alzheimer CAREGIVERS? Get on you computer and demand equal research for Alzheimer's as they provide AIDS/HIV. It's a crying shame that Alzheimer's is the only INCURABLE Disease in the World. Where are our priorities, free Aids and HIV med's to all people behind bars in our prisons and that carries over to when they are released. C'mon ya'll let's at least come up with a treatment that will stop the Alzheimer's progression.

    July 19, 2011 at 00:01 | Report abuse | Reply
    • Brad

      I'm all for alzheimer's research. But you overstate and are incorrect that AD is the only Incurable disease in the world. Too bad that wasn't true. The subject of this article, HIV, is not curable but treatable. Multiple Sclerosis, Parkinson's Disease, etc, etc are all incurable. My mother died of AD, so I'm right with you on pushing for treatment/cure, but fighting another disease (AIDS) that kills so many in the prime of their lives (esp. in Africa) is certainly a worthy venture.

      July 19, 2011 at 03:51 | Report abuse |
    • JLS639

      The reason we spend more on HIV has a lot to do with the fact that our HIV therapies are effective enough to go to large scale clinical trials. Alzheimer's, on the other hand, has almost no treatments, and those are not very effective. Research into AD keeps revealing that this therapy or that therapy will not work. We have no good animal models of AD, but good animal models exist for AIDS. HIV infection can be detected early for early treatment, but AD usually cannot be detected until 80-90% of the relevant neurons are dead. There is not much you can do at that stage.

      July 19, 2011 at 09:25 | Report abuse |
    • Brandonj

      Alzheimer's is hardly the only incurable disease. HIV/AIDS is incurable (once you test positive, it never goes away-it might be undetectable but it's still there), Diabetes is incurable (Type 1 and many cases of Type 2 cannot be cured by any means currently known to medical science), Cancer in many forms is incurable, Herpes is incurable, and the list goes on and on. Some diseases are a real threat and kill people in the prime of their lives, other are mere annoyances, and others tend to afflict the elderly at the end of their lives. My grandfather had Alzheimer's for seven years before his death at age 83. While his last years were not of the best quality, he lived a long and full life (he would have even said that before the Alzheimer's). We do need to make more strides in Alzheimer's treatments, but to say that Alzheimer's is of equal importance to diseases which strike down people before they've had a chance to really live their lives is really rather selfish.

      July 19, 2011 at 15:58 | Report abuse |
  9. Aene

    I don't have AIDS.

    July 19, 2011 at 09:45 | Report abuse | Reply
  10. tru

    What about the wife who gets aids from her husband because he was on the down low? I'm sure she didn't expect for her husband to wear a condom. What about the husband who's wife gives him aids because she slept around? I'm sure he didn't expect to wear a condom. What about a unborn child who's mother is HIV positive? I'm sure that child didn't ask for that. We do have choices and I agree; why blame society for choices that we make. Alzheimers although not heavy on research is far more if not just as important in finding a cure. I would have to agree that research should be more dedicated to finding a cure and a more sensitive and unplanned disease. Controllable verses uncontrollable. Sarah your situation is impressionable and I'm sure he is terrified of his status more than you. However, I respect your non-judgement towards him because we all can be there. Its just amazing how we take for granted what we don't have and instead point and ridicule those that do. Always remember we all can be touched.

    July 19, 2011 at 12:47 | Report abuse | Reply
  11. fernace

    The reason Alzheimers is not in the category of AIDS is simple. It is a) not a communicable disease, b)not considered an epidemic. If your spouse has Alzheimers you can't contract it by any type of contact. The same is not true for AIDS, which is at this point a pandemic! Also, if we don't stop the spread of this deadly disease more whole families will have it, spread it & die from it! It's already happening in the countries mentioned in the article, & to a lesser degree in our own. I know a young couple who are infected. He contracted it from needle sharing, she got it from him. Neither knew they had it til she got pregnant. They are successfully keeping the disease at bay with meds & so far both babies test negative! This is a young family, all of whom are living with a potential death sentence! That's the difference between the 2 diseases, governmental urgency!!

    July 19, 2011 at 12:49 | Report abuse | Reply
  12. myhepcdiary

    Also...if you need to have a pharmaceutical spin on it...there are two exciting new drugs out to report on and several more in advanced clinical trials.... awareness is so important and most people know NOTHING about this disease....

    July 28, 2011 at 19:48 | Report abuse | Reply
  13. Jessica Adams

    That's really a great news. Thanks for the nice post. we should have deep knowledge about HIV. Its really a dangerous disease. It can finish our life.

    Aids HIV Cure

    August 5, 2011 at 00:29 | Report abuse | Reply

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