Combining PrEP and ART could almost eliminate HIV infection

  • Posted by a hidden member.
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    Mar 07, 2015 2:41 AM GMT
    I'm putting this in the "All Things Gay" category because it has wide ranging effects, especially in the Gay community.

    While it had a 96% reduction rate, it is important to note that the TWO infections were from partners who were neither on ART or PrEP. Studies like this depends a great deal on drug adherence. The reduction was 100% for couples (even external affairs) if either or both were on antivirals.
    This study was a first in a number of ways. It is the first to combine the ideas of PrEP and of 'treatment as prevention' in a systematic and sequenced way. It is the first large study in Africa to use a ‘risk score’ specifically to target the intervention to those most at risk of HIV. And it is the first study of treatment as prevention to document near-elimination of HIV transmission not just from the HIV-positive partner in a serodiscordant couple, but also from extramarital partners.

    The Partners Demonstration Project combines PrEP and ART with the idea of using PrEP as a ‘bridge’ to fully suppressive ART in the relationship. The HIV-negative partner is offered PrEP as long as the HIV-positive partner is not on ART, and also for the first six months the HIV-positive partner is on ART. The six-month overlap period gives time for the person starting ART to become undetectable, but can be extended if adherence is known to be poor.

    The HIV incidence results in the Partners Demonstration Project are not compared with a placebo or control group who do not get PrEP and/or ART, as the evidence for the effectiveness of both is now so strong it was thought unethical to withhold them. Instead, the results are being compared with a historic control – HIV incidence in the placebo arm of the original Partners PrEP study, adjusted for the characteristics of the couples in the new study.

    During the period studied, in 48% of couples the HIV-negative partner was taking PrEP, in 27% both partners were taking PrEP or ART, in 16% the HIV-positive partner was taking ART alone, and in 9% neither partner was taking antiretrovirals (ARVs).

    neither person infected was in a couple where one or both was taking antiretrovirals. The first woman infected (both were women) had split up with the man she had enrolled with and had stopped taking PrEP. The second infection was in a couple where the HIV-positive partner had a high CD4 count and did not wish to take ART, and the HIV-negative partner had stopped taking PrEP. Neither woman had detectable tenofovir in her blood at the time she was infected.

    ....the strategy had huge potential for prevention in other people at high risk, such as men who have sex with men and single women at risk.
  • NeuralShock

    Posts: 411

    Mar 08, 2015 1:54 AM GMT
    Very promising data! I love it icon_biggrin.gif

    Very much a bright future ahead for all society if this goes through!
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    Mar 09, 2015 9:31 PM GMT
    robbaker saidBut does it help against other stds besides hiv ? One should always still wear a condom

    No but it doesn't cure the common cold either. Don't minimize HIV to just another STD. I've lost 40 or so friends to AIDS. None of them died from syphilis or gonorrhea.
    "Always wear a condom" is great.....if you can do it 100% of the time. Over 50% don't. And many are "some of the time." And if you do use condoms and it breaks, slips, etc., wouldn't it be better if your partner was on PrEP or Undetectable?

    Even in a relationship that is not totally monogamous, it's important that one or preferably both are on anti-virals.

    Even in the scenario in the report, 2 women didn't use their PrEP and one's male partner didn't use his ART(!!!!), stupid pair perhaps.....but human. The other woman got HIV after she broke up with her POZ Undetectable partner.

    There are now at least five strategies that reasonably constitute‘safe sex, provided that certain parameters are met.
    They are:
    1.The use of Condoms during casual encounters between men of unknown or discordant serostatus.
    2.HIV negative men taking effective pre-exposure prophylaxis (PrEP).
    3.Men living with HIV who only have sex without condoms when they have a sustained undetectable viral load (UVL) and in the absence of sexually transmissible infections (STIs).
    4.Effective use of serosorting between HIV positive men.
    5.Effective negotiated safety agreements.
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    Mar 09, 2015 9:47 PM GMT
    timmm55, THANK YOU!

    My partner and I practice monotony, I mean 'monogamy', but otherwise we would definitely use every preventive approach possible when it comes to HIV.

    I'm sure there are some risks with the use of these meds----but absolutely nothing as consequential as the risks involved with becoming HIV positive for the rest of one's life.