View Full Version : NYT: Test and Treat works for prevention

January 10th, 2012, 08:14 AM

What I love is the interesting fact buried in the original story (of a clinical trial SO SUCCESSFUL that they terminated it prematurely) is that this related mostly to heterosexual couples, although the groups referenced in the NYT article was about homosexual men and IV drug users.

Link to the original study protocol: http://www.hptn.org/research_studies/hptn052.asp

Another interesting thing I noted while looking at enrollment data: nobody was from the US or Canada. Or Europe. The one US location (Boston) de-enrolled from the study.

Wasn't there another (European?) study last year that indicated INCREASED infection rates in serodiscordant couples in which one was treated?

John Bleau
January 10th, 2012, 07:32 PM
The test began in 2005. 27 seroconversions among about 900 couples in 6 years. That should say something about its transmissibility.

The NYT article says that immediate treatment lowers AIDS deaths, but the NIH article says: "There were also 23 deaths during the study. Ten occurred in the immediate treatment group and 13 in the deferred treatment group, a difference that did not reach statistical significance."

A quote from another NYT article in the chain goes: "Dr. Coates of U.C.L.A. said he hoped that treatment delays would fade away because the newest antiretroviral drugs had few side effects." but the NIH article does mention that among the drugs used is: "zidovudine/lamivudine (150 mg lamivudine/300 mg zidovudine taken orally twice daily)" which I would hardly qualify as having few side effects.

It's problematic that the test subjects come said disparate third world areas. You only need one or two of these to be corrupt for the figures to be useless. Also problematic is that there were actually "a total of 39 cases of HIV infection", not 28, and these extra 11 were said to be from some strain of the virus not found in the partner. This genetic typing is suspect to me. After all, we still don't have a gold standard.

Finally, after older studies indicating approximately 30% reduction in transmission, we get this 96%, the kind of figure they'd been praying for all these years and getting it only now? Strains my credulity. I guess it's summed up with the obligatory call for more money at the end of the NYT article: "Dr. Montaner said he is frustrated that rich countries will not donate enough money to roll out the strategy in poor countries with huge H.I.V. epidemics."


January 10th, 2012, 07:59 PM
What I find troubling is that this study is being used to justify the BC policy that has given me (personally) such problems. CIC is not sophisticated enough to understand the methodological problems in studies of this type.

Thanks for the added commentary John, I hadn't gone through the details of the study yet (it was late last night when I found this, and while I read some of the materials I hadn't had a chance to go through it all.)

January 10th, 2012, 08:35 PM
Injection drug users (IDUs) are an important population with respect to HIV treatment as prevention because they are often less likely to access HAART in comparison with other risk groups.

The study is reserved to IDUs. I think it is ridiculous. Couples usually get drugs together, and so they have a common risk factor.
Even in the remote possibility one taking drugs and the other not taking, I suppose there may be a chemical induction, through sex, rather than viral induction. Although this last one has never been investigated, it is possible IMO.
EDIT: The ARVs inhibit the process of excess antibody production in every case, I suppose.