Earlier HIV therapy protects against virus spread


The nine-nation study offers convincing evidence of what scientists have long believed - that HIV medicines don't just benefit the patient, but may act as a preventive by making those people less infectious. Earlier treatment in the study meant patients were 96 percent less likely to spread the virus to their uninfected partners, according to preliminary results announced Thursday by the National Institutes of Health, which oversaw the research.


When HIV patients should start taking antiviral drugs is an important question. The pills are lifesaving but also expensive - up to $15,000 a year in the U.S. - and carry a range of side effects from diarrhea to liver damage.

NIH's Dr. Anthony Fauci said the new study promises to change practice worldwide. In developing countries, where the drugs cost a few hundred dollars a year, patients tend to be far sicker before getting medication. Even in the U.S., where therapy starts sooner, doctors don't always treat as early as was done in this study.

"It has less to do with a decision about what's good for you from a personal health standpoint than what is the extra added benefit from starting earlier, i.e., transmission, especially if you have a partner who's uninfected," said Fauci, director of the National Institute of Allergy and Infectious Diseases.

Condoms remain crucial for protection - the medications don't change that longtime recommendation. All 1,763 couples in the study, where one partner had HIV and the other didn't, were urged to use them.

"HIV-positive people cannot assume they are not infectious simply because they are already on treatment medications," warned Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention.


The couples, most of whom were heterosexual, were randomly divided. Among half, the HIV-infected partner started medication immediately after diagnosis. Among the other half, the infected partner delayed using the drugs until his or her level of CD4 cells - a way to measure the strength of the immune system - dropped below 250 or symptoms appeared.



Importantly, more than half of those infections occurred when the patient's CD4 count remained greater than 350, Fauci noted. That number indicates only moderate immune damage. Most developing countries don't offer treatment until CD4 levels dip lower than that.


