Two big studies detailed Monday confirm that earlier treatment for the AIDS virus not only keeps people healthy, but prevents them from infecting others.
The results have AIDS experts more optimistic than ever that it’s possible to put a serious dent into the pandemic of human immunodeficiency virus (HIV), which has killed nearly 40 million people and which infected close to 37 million more.
"The road for us going forward is very clear," said Dr. Julio Montaner, director of the British Columbia Centre for Excellence in HIV/AIDS.
"We have now the unique opportunity of ending the pandemic," Montaner told the meeting of the International AIDS Society in Vancouver, Canada.
“We have now the unique opportunity of ending the pandemic."
Efforts to get more drugs to more people, to distribute condoms and clean needles, and to educate people about HIV have already had enormous effects on slowing the deadly virus. Just last week the United Nations AIDS agency UNAIDS reported that such efforts had saved 8 million lives.
And the two large, global studies of using drugs to stop the spread of AIDS have had convincing results, researchers told the conference.
One study had such clear results that it was stopped last May so everyone could get the drugs.
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Now, more analysis of the data shows that not only does early treatment prevent side-effects and keep the virus under control, but it also prevents the illnesses caused as the virus ravages the immune system, including pneumonia and cancer. These are the diseases that define acquired immune deficiency syndrome, or AIDS.
"Based on the new data and analysis, the study now reports the overall risk of developing serious AIDS events, serious non-AIDS events, or death, was reduced by 57 percent among those in the early treatment group, compared to those in the deferred group,” the National Institute of Allergy and Infectious Diseases (NIAID), which helped pay for the study, said in a statement.
“Non-AIDS-related events tracked by the study included cardiovascular disease, end-stage renal disease, liver disease, non-AIDS defining cancer or causes of death not attributable to AIDS. Serious AIDS events were reduced by 72 percent and serious non-AIDS events were reduced by 39 percent.”
Some people had feared that it would be too hard for people to stay on strict drug regimens so early after being infected, and that they’d either develop side-effects or the virus would become resistant to the drugs. Neither happened to any large degree.
"This study conclusively shows that the benefits of early therapy far outweigh any adverse outcomes, and reinforces recommendations to offer immediate antiretroviral therapy to all patients," said NIAID director Dr. Anthony Fauci.
"Today’s findings show that early antiretroviral treatment presents no additional risk of serious, non-AIDS-related disease to people taking treatment, but actually confers valuable protection against these illnesses, helping keep HIV-infected people healthier longer."
The study included 4,600 people in 35 countries who got treatment either as soon as possible after diagnosis, or who were told to wait until there were signs of immune system damage.
The case of a French teenager bolsters this argument. She was infected at birth and was given a strong cocktail of four HIV drugs, but then her mother stopped bringing her for treatment when she was 6. Twelve years later, the girl, now 18, hasn’t taken drugs yet has almost no evidence of infection.
'This girl has none of the genetic factors known to be associated with natural control of infection," said Dr. Asier Sáez-Cirión, of the Pasteur Institute in Paris. "Most likely she has been in virological remission for so long because she received a combination of antiretrovirals very soon after infection."
A second big study shows that giving people drug cocktails protects others.
“These findings illustrate that treatment is an incredibly powerful tool for HIV prevention.”
"Throughout our decade-long study with more than 1,600 heterosexual couples, we did not observe HIV transmission when the HIV-infected partner’s virus was stably suppressed by antiretroviral therapy," said Dr. Myron Cohen of the University of North Carolina at Chapel Hill, who led the study.
'These findings illustrate that treatment is an incredibly powerful tool for HIV prevention."
Cohen said three people in the group whose partners or spouses were treated for HIV got infected over four years, compared to 43 whose partners were not treated.
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"The study now makes crystal clear that when an HIV-infected person takes antiretroviral therapy that keeps the virus suppressed, the treatment is highly effective at preventing sexual transmission of HIV to an uninfected heterosexual partner," said Fauci. "For heterosexuals who can achieve and maintain viral suppression, the risk to their partners is exceedingly low."
In the United States, more than 1.2 million people have HIV, and about 50,000 people are newly infected each year. Medications can keep infected people healthy, but there is no cure and no vaccine.
Scientists have now created some two dozen different drugs that can slow down the virus.