The Scientific Breakthrough of 2011

National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institute of Health (USA) conducted a large scale clinical study, which revealed that the use of oral antiretroviral medicine by those affected with HIV significantly reduces the risk of transmission to their partners.

According to NIAID Director Anthony S Fauci, “This new finding convincingly demonstrates that treating the infected individual and doing so sooner rather than later can have a major impact on reducing HIV transmission”.

The central idea behind starting this project known as ‘START’ (Strategic Timing of Antiretroviral Treatment) was to determine the appropriate timing when antiretroviral should be prescribed to a person affected with HIV. The study entailed examining whether immediate antiretroviral treatment among HIV- infected individuals with CD4 levels above 500 cells/mmis better than deferring treatment until CD4 counts fall below 350 cells/mmin terms of potential benefits and risks, such as developing AIDS and other serious illnesses, including cardiovascular disease, cancer, kidney failure and liver diseases or death. (CD4+T-cells commonly known as CD4 count is a key measure of immune system health in case of HIV infected individuals.)

The study began in April 2005 enrolling 1763 couples, all at least 18 years of age, and was headed by Myron Cohen, the Director of the Institute for Global Health and Infectious Diseases at the University of California. The scope of the study remained confined to heterosexual couples and therefore its findings cannot be applied with absolute certainty to homosexual partners.

The study was conducted in 13 cities in Bostwana, Brazil, India, South Africa, Thailand, USA and Zimbabwe. The couples were divided into two groups while the infected partners in the first group was immediately prescribed a combination of three antiretroviral drugs, the infected partners in the second group began with the medication when their CD4 counts fell below 250 cells/mm3 or an AIDS related event, such as pneumocystis, pneumonia occurred.

DSMB (Data Safety and Monitoring Board), which was responsible for releasing the interim review of this study found a total of 39 cases of HIV infections among previously uninfected partners. Out of these 39 cases there was only one case among those couples where the HIV infected partner began immediate antiretroviral therapy. This was a major success point for the researchers as it proved that the early initiation of antiretrovirals can lead to a 96 per cent reduction in HIV transmission to the uninfected partner.

However, not all went well for the researchers given the fact that there were 23 deaths during the study out of which 10 occurred in the immediate treatment group and 13 in the deferred treatment group. These statistics fail to match up to the positive results, which the scientists have otherwise claimed with respect to other results that were obtained.

The NIAID had declared that apart from examining the use of antiretroviral therapy they also sought to observe the genetic variants of the virus on the progression of untreated HIV, comparing the early and deferred antiretroviral groups for neurocognitive function and measures of vascular function, pulmonary function and bone mineral density. In addition it also sought to evaluate participant understanding of study information and satisfaction with the consent process to better inform future research guidelines.

More than 60 million have been infected with HIV in the last thirty years and around half of them have lost their lives and this calls for a sustained research in developing better medication. An HIV/AIDS vaccine is the need of the hour and we need to look forward and work towards a future where AIDS related deaths, new HIV infections and discrimination against HIV positive individuals would be nil.                

Arpita Roy