This article was originally posted on May 12 at http://www.TheEconomist.com by G.C.
TEN years ago, at the inflection point in attitudes to the AIDS epidemic when both drugs and money to deal with it were rapidly becoming available in serious quantities, there was an acrimonious debate between medical experts and activists about what to do with those drugs and that money. Some (mainly the medical experts) wanted to concentrate on breaking the chain of transmission by stopping new infections. Others (mainly infected activists) wanted to concentrate on treating those already harboring HIV. Neither, oddly, considered that the same approach might be used to do both.
But it can. That is the conclusion of a study that has just been stopped, because its results are so decisive that it was considered immoral to keep on denying treatment to those in the control arm, who were acting as a benchmark against which the approach could be judged.
The trial in question, organized by an international body called the HIV Prevention Trials Network, and paid for by America’s National Institutes of Health, asked whether treating an infected individual with drugs that suppress his level of HIV also stops him passing the virus on. It turns out that it does. HPTN 052, as the trial is known, recruited 1,763 established couples (97% heterosexual, 3% male homosexual) in which one partner but not the other was infected. The couples came from 13 places in Africa, Asia and North and South America. The crucial point was that the infected individual in the couple was not ill enough to qualify for treatment under existing guidelines for drug use. Those guidelines are in place partly to avoid inflicting unnecessary side-effects on patients and partly to reduce the risk of drug-resistant strains of the virus developing.
Half of the volunteer couples were treated according to the existing guidelines, with the infected partner being offered drug treatment only if his or her condition (as measured by the level of a particular immune-system cell in the bloodstream) dropped below a critical threshold, or if he or she developed actual symptoms of AIDS. In the other half, the infected partner was put straight onto drugs. All couples were also counseled in transmission-avoidance and were given free condoms and treatment for other sexually transmitted diseases, as well as regular medical check-ups.
The study began in April 2005. Since then, 28 people have transmitted the virus to their partners. Of those, 27 were in the control group and only one in the experimental arm of the trial. Drugs, in other words, do stop transmission as well as saving lives. You can have your cake and eat it.
This is a decisive result, and a triumph both for the study’s organizers, and for Julio Montaner of the University of British Columbia, who pioneered this approach and has been pushing for its implementation for years. AIDS is by no means beaten, but now it may be on the run.
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