THIS is an article that appeared in the New York Times on July 22, 2015 following the recent HIV conference in Vancouver, and was written by DONALD G McNEIL Jr.
Taking an antiretroviral drug daily shielded 76 per cent of young African women assigned the drug — a particularly hard group to protect — against HIV infection, researchers have said as they reported the results of a three-nation clinical trial.
The study, called Adapt, found that wide majorities of young women in Cape Town, South Africa — as well as gay men in Bangkok and younger gay men in Harlem — were willing and able to take the pills daily. Previous studies have shown that taking the drug, called Truvada, faithfully every day provides nearly perfect protection against HIV, even in people having regular unsafe sex.
Participants had regular blood tests and used pill bottles that sent an electronic signal to monitors each time they were opened. Some earlier prevention studies in African women failed because the subjects threw away their pills or protective vaginal gels.
Sometimes their partners objected to the drugs, and sometimes women feared that having antivirals in the house would suggest to nosy neighbors or relatives that they had already been infected.
Dr Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, called the results of the Adapt study encouraging. The research was funded by the National Institutes of Health.
The study, a preliminary Phase two study with about 500 participants in three countries, was one of many released at the International AIDS Society conference. Several added to evidence about various strategies that are being tried in the fight against AIDS, though none were major breakthroughs.
Proof continued to mount that it is crucial to treat HIV patients as soon as possible after infection because they will stay healthier, live longer and stop infecting others.
Two studies producing conclusive evidence at the conference surprised no one. While first-generation drugs had harsh side effects, a decade of studies done with milder second-generation drugs have reached similar conclusions about early treatment.
In May, a major study, known as Start, had to be stopped early because it was clear that early treatment was so much better that it was unethical to let anyone wait months for it.
Virtually all top AIDS experts now advocate testing and treating all the 37 million people estimated to be infected around the world. The biggest obstacle is money.
Right now, about 15 million people are on the drugs, and an additional two million get infected each year. An additional US$8 billion to $12 billion is needed annually to turn the epidemic around, according to UNAIDS, the United Nations AIDS-fighting agency.
But donations have essentially been flat since the 2009 recession. Most recent gains have come because drug prices have fallen, clinics have become more efficient and affected countries like South Africa are paying more of their own costs.
“We have no time to waste, as the next five years represent a brief window of opportunity,” said Michel Sidibé, the executive director of UNAIDS.
Wealthy countries with sophisticated medical care have developed a separate problem. Some patients able to get frequent CD4 counts — a measure of how far their immune systems have deteriorated — still delay starting treatment for HIV infection.
Ultimately, they not only die sooner but infect others while they wait.
“People have gotten the message that they are ‘healthy’ until a certain CD4 count, which is certainly not correct,” said Dr Myron S. Cohen, an AIDS expert at the University of North Carolina at Chapel Hill.
After one initial CD4 count, the test — long a staple of HIV medicine — should be abandoned, he said. Such a radical policy change will take time, he added.
Two new attempts to pay teenage girls in Africa to take actions that might prevent infections failed, adding to the confusion over a controversial worldwide trend in public health: paying the poor to help themselves.
Some donors are reluctant to pay rewards for avoiding risks — like having unprotected sex with people of unknown H.I.V. status — that common sense dictates people should avoid anyway.
AIDS scientists often counter that the subjects they pay are essentially helpless: that young African girls whose parents have died of AIDS or teenage American boys ejected from their families for being gay often have no choice but to have sex for money with predatory older men and cannot dictate whether condoms are used.
In one study at the Vancouver conference, girls and their families were paid up to $30 a month in return for the girls’ attending school regularly.
In the second, more complex investigation, girls could earn up to $175 over two years for achieving a mix of goals, including passing school exams, taking a life-skills course that included safe sex instruction, getting H.I.V. tests and writing papers about what they had learned.
In neither case did payments make a marked difference in HIV rates. In the second study, slightly more girls who were paid got HIV, although the difference was statistically irrelevant. But 24 per cent fewer got herpes.
In both studies, girls who stayed in school, paid or unpaid, were less likely to get infected. And girls who earned the most at the various scholarly tasks, suggesting that they were just better students, also were infected substantially less often.
“Is it the smarter kids?” asked the lead investigator, Quarraisha Abdool Karim, an epidemiologist at Columbia University and the University of KwaZulu-Natal. “Is it the intervention? Or is it another factor? I’m not sure. But we really have to do more to lower the infection rate in young women.”
Typically in Africa, five or more female high school students are infected for every one of their male classmates, Dr Abdool Karim said. “So it’s not peers infecting each other,” she said.
Also at the conference, researchers from the Pasteur Institute in Paris described an unnamed teenager born with HIV and on drugs from birth to age six, at which point her mother stopped giving her the medicine. Even though the young woman has been off drugs for 12 years, her virus has not rebounded, although trace amounts persist.
Though the case was an encouraging sign, experts said, another famous child whose early medications were stopped — the “Mississippi baby” — eventually had a viral relapse and needed treatment again.
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