Experts have emphasized the critical role of expanding access to HIV treatment under a "Treatment as Prevention" strategy to stop the HIV pandemic.
Dr. Julio Montaner, director of the BC Centre for Excellence in HIV/AIDS (BC-CfE) and Past President of the International AIDS Society (IAS) - strongly reinforces the view that the benefits of highly active antiretroviral therapy (HAART) extend beyond the remarkable effectiveness of the treatment to prevent the onset feedproxy.google.com
An HIV-positive person who takes anti-retroviral drugs after diagnosis, rather than when their health declines, can cut the risk of spreading the virus to uninfected partners by 96%, according to a study.
The United States National Institutes of Health sampled 1,763 couples in which one partner was infected by HIV.
It was abandoned four years early as the trial was so successful.
The World Health Organization said it was a "crucial development".
The study began in 2005 at 13 sites across across Africa, Asia and the Americas.
HIV-positive patients were split into two groups. In one, individuals were immediately given a course of anti-retroviral drugs.
The other group only received the treatment when their white blood cell count fell.
Both were given counselling on safe sex practices, free condoms and treatment for sexually transmitted infections.
Among those immediately starting anti-retroviral therapy there was only one case of transmission between partners.
In the other group there were 27 HIV transmissions.
"This breakthrough is a serious game changer and will drive the prevention revolution forward. It makes HIV treatment a new priority prevention option," said Michel Sidibe, executive director of the Joint United Nations Programme on HIV/Aids (UNAIDS).
But he warned that it would cost more than ten billion dollars to provide drugs to the ten million people worldwide who are currently not receiving medication for HIV.
The World Health Organization says sexual transmission accounts for 80% of all new HIV infections. Its director general, Dr Margaret Chan, described the announcement as a "crucial development"
She added: "The findings from this study will further strengthen and support the new guidance that WHO is releasing in July to help people living with HIV protect their partners."
The value of anti-retrovirals, in preventing transmission, had been speculated for some time after observational studies, but researchers say this is the first time it has been proven in clinical trials.
Keith Alcorn, from the NAM, an HIV/AIDS charity, said: "This study resoundingly confirms what lots of smaller studies have been telling us for several years.
"International donors cannot ignore the evidence any longer: HIV treatment is a very powerful form of HIV prevention, and could have a major effect on the HIV epidemic in the worst-affected countries.
"What we need now is a renewed commitment to HIV treatment, and studies to show how to get the maximum benefit out of this breakthrough at country level."
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Ago at a media event on the treatment of hepatitis B, and from Beijing Ditan Hospital of Infectious Diseases of Professor Cai Haodong to four commonly used clinical characteristics of hepatitis B treatment and safety were made interpretation. Lamivudine: majority of adverse reactions occurred in HIV treatment both lamivudine is a cure for AIDS, but /diseased-guangzhou-daily-in-the-end-of-hepatitis-b-antiviral-safe-to-24074.html" " target="_blank" rel="nofollow">
HCV-related liver fibrosis progresses with antiretroviral therapy interruption
Last Updated: 2011-03-29 17:59:31 -0400 (Reuters Health)
By Will Boggs, MD
NEW YORK (Reuters Health) - Liver fibrosis progression follows interruption of antiretroviral therapy (ART) in patients co-infected with HIV and hepatitis C virus (HCV), researchers from Canada report in the February 16th online issue of AIDS.
"HIV treatment interruptions may be particularly harmful for patients co-infected with HIV and hepatitis C," Dr. Marina B. Klein from McGill University in Montreal told Reuters Health in an email. "Efforts are needed to engage patients in care and support their long-term adherence to therapy so as to reduce the burden of liver disease among co-infected persons."
Dr. Klein and colleagues in the Canadian Co-infection Cohort Study (CTN222) used the aspartate aminotransferase (AST)-to-platelet ratio index (APRI), a validated surrogate marker for liver fibrosis, to assess the impact of ART interruption on fibrosis progression in 541 HIV/HCV-co-infected patients followed for a median of 1.02 years.
"We had hypothesized that treatment interruptions might be related to liver fibrosis progression, particularly because the results of treatment interruption trials such as the SMART study suggested that hepatitis co-infected persons are at particular risk for adverse events, probably because of enhanced inflammation when HIV rebounds after stopping treatment. The liver could also be susceptible to such inflammation and thus be further damaged in the setting of a treatment interruption," Dr. Klein explained.
There were 55 treatment interruptions of at least 14 days in 53 patients. Among the 21 patients with complete data, the median change in platelet count after the treatment interruption was -2 billion/L and the median change in AST after the treatment interruption was 21 U/L.
After adjustment for other factors, treatment interruption was significantly associated with progression of liver fibrosis. Baseline APRI score of at least 0.5 also predicted fibrosis progression, whereas CD4+ T cell count, HIV viral load, age, and gender were not significant predictors.
Treatment interruption was associated with a significant increase in APRI score to at least 1.5 (predictive of significant fibrosis) after adjustment for time-varying confounders (hazard ratio 2.52). The association with an increase in APRI score to at least 2.0 (predictive of cirrhosis) failed to reach statistical significance in the multivariate model.
"A possible explanation for the association of interruption with developing liver fibrosis even after accounting for changes in CD4+ T cell counts and HIV RNA may be that interruption increases inflammatory processes," the researchers say.
"Our findings underscore the need to find better strategies to improve continuous ART exposure among co-infected persons," the authors conclude.
"We are currently planning to investigate how inflammation may contribute to liver disease over time and to assess how HIV and HCV treatments may affect the inflammatory response," Dr. Klein concluded.
An orphan drug originally used for HIV treatment has been found to short-circuit the process that results in additional sensitivity and pain from opioid use. The study by researchers at the Indiana University School of Medicine is reported in the March 25, 2011 issue of Brain, Behavior and Immunity.
Source: Indiana University School of Medicine - Discipline: Physiology www.labspaces.net
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