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Treat patients early to stop HIV spread, study finds

Treat early. That’s become the mantra of the AIDS world. While previous studies have shown that early treatment benefits infected individuals, now a watershed study shows it prevents them from spreading the virus to others. According to results of the major clinical trial, patients were 96 percent less likely to pass on the virus if they took antiretroviral drugs early on. That’s a staggering figure.

"These results are phenomenal,” Thomas J. Coates, PhD, at UCLA was quoted as saying in the New York Times. “It was a tough study to do, and I’m thrilled it came out this way.” Coates is a guru of the AIDS prevention world; he founded the Center for AIDS Prevention Studies at UCSF, where I collaborated with him in 1998 on a monograph on new AIDS drugs.

The study is not the first to suggest that early treatment prevents transmission, but it is the first randomized clinical trial to validate the strategy. The $73 million trial was scheduled to end in 2015 but was halted early by the NIH, its sponsor, because the results were so compelling.

The trial, begun by researchers at the University of North Carolina at Chapel Hill in 2005, involved 1,763 heterosexual couples at 13 sites in the United States and abroad. In one group, patients identified as HIV-positive were given drugs immediately. In the second group, infected patients received drugs only after their CD4 counts - a measure of immune system health - fell below 250 or they developed an AIDS-related complication. Both sets of couples were counseled on safe sex, given free condoms and regularly tested for HIV.

There were 27 new infections among the 877 couples in which the HIV-infected individual did not receive treatment right away. Only one new infection was found among those where the HIV-infected partner began immediate antiretroviral treatment.

These dramatic findings are sure to changing the prescribing habits of physicians, making it clear that early access to treatment is critical.

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