Contrary to the former HIV treatment guideline that instructs people to commence antiretroviral drug (ARD) only when CD-4 count is low, new treatment guideline from World Health Organization (WHO) demands that all HIV positive person should be on antiretroviral drug once tested positive. The same guideline recommends lifelong antiretroviral treatment (ART) for pregnant and nursing mothers regardless of their CD4 count or clinical stage, so as to prevent Mother-To-Child-Transmission (MTCT) of the virus.
Mother-to-child transmission (MTCT) accounts for over 90% of new HIV infections among children, the report says.
The guideline explains that early and lifelong application of antiretroviral therapy by infected persons can suppress the HIV epidemic to undetectable levels, although they do not completely eliminate HIV from the body.
By suppressing the amount of virus in the body, the report says people infected with HIV can now lead longer and healthier lives without infecting new people.
The ARTs will reduce the risk of HIV transmission to the baby and protect the mother’s health during and after pregnancy. ARTs should be taken as soon as possible after diagnosis (within 7 days). Treatment should be maintained after delivery and completion of breastfeeding for life.
The move according to WHO, could avert an additional 3 million deaths and prevent 3.5 million more new HIV infections between now and 2025.
Two other studies also found that use of antiretroviral medications may also help protect HIV negative people from contracting the virus through sexual contact.
The studies were conducted in Africa among heterosexual couples, and they provide the first evidence that the strategy, which is called pre-exposure prophylaxis, may help both men and women.
The first study, called ‘The Partners PrEP Trial’, followed 4,758 couples, in which one member has HIV and the other does not, in Kenya and Uganda. All couples were given intensive counseling about safer sex practices, contraceptives, condoms, and monitoring and treatment for STDs.
The couples were evenly divided into three groups: one took a daily placebo pill, the second got a daily dose of the drug tenofovir, and a third was assigned to a daily combination pill with the drugs tenofovir and emtricitabine, which is sold under the brand name Truvada.
After 36 months, 78 new HIV infections had occurred in the study. There were 18 in those taking tenofovir alone, 13 in those assigned to the combination pill, and 47 among those who were taking a placebo.
Those who were taking tenofovir alone had an average of 62% fewer HIV infections, while those who received the combination pill had 73% fewer infections than those on the placebo. The differences between the two groups were not statistically significant, meaning one regimen was not better than the other.
Researchers reported having very high levels of medication adherence in their study, saying that more than 97% of dispensed pills were taken. That was determined by the number of pills that were returned to study investigators at monthly check-in visits. Researchers have also taken blood tests to confirm blood levels of the study medications, but those results have not yet been analyzed, they said.
An independent panel of experts found the early results of the study so compelling that they ordered the placebo portion of the study stopped early so that those participants could have access to the study medications.
The study was funded by the Bill & Melinda Gates Foundation.
The second study, called the TDF2 trial, directed by the CDC, tracked about 1,200 young, sexually active men and women in Botswana and Uganda. None had been previously infected with HIV.
They were randomly assigned to take either a daily placebo pill or Truvada.
After roughly three years, there were nine new HIV infections among adults taking Truvada compared to 24 in those assigned to the placebo, representing a 63% reduction in infection risk.
Among those who were thought to have taken the study drugs as directed, protection was even greater, rising to 78%.
Researchers said adherence to the medication regimens was high. About 84% of people in the study took their pills as directed, as determined by pill counts at regular check-in visits.
Additionally, there were no safety concerns identified in either study.
Another trial showed the drugs could cut HIV transmission among men who have sex with men by as much as 90% among those who used them consistently.