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January 24, 2013

U.K. Throws Weight Behind Treatment as Prevention Model

The U.K. Department of Health has published a position paper by England’s Expert Advisory Group on AIDS (EAGA) and the British HIV Association (BHIVA) on the use of antiretroviral therapy to prevent HIV transmission, calling vaginal transmission risk “extremely low” when the HIV-positive partner maintains an undetectable viral load and is free of sexually transmitted infections (STIs). The paper also asserts that successful ARV therapy is “as effective as consistent condom use in limiting viral transmission.”

Drawing upon studies such as the famed HPTN 052 trial that showed a 96 percent reduction in transmission risk when the HIV-positive partner of a serodiscordant heterosexual couple is taking effective HIV meds, EAGA and BHIVA recommend health care professionals discuss with their HIV-positive patients how proper ARV use may help prevent transmission. Their paper also encourages providers to discuss the potential for beginning therapy with those people living with the virus who wish to reduce their likelihood of transmitting to others.

The paper delineates three caveats that must be in place to ensure the best possible protection against transmission in heterosexual couples:

  • Neither partner must be infected with an STI (which can both make people more susceptible to becoming infected with HIV and which can raise viral loads in people living with the virus, making them more infectious).
  • The HIV-positive partner must have sustained an undetectable viral load for more than six months and have had an undetectable viral load on his or her last test.
  • Viral load tests should be conducted every three to four months.
While the authors of the paper acknowledge that there has been insufficient research to indicate whether ARVs protect similarly with sexual practices outside of vaginal sex, such as anal sex, they assert their expert opinion that the “extremely low risk” is likely similar when the above conditions are met.

“It must be noted that no single prevention method can completely prevent HIV transmission,” the paper states. “Antiretroviral therapy reduces the risk of transmission only of HIV. Irrespective of antiretroviral therapy, condoms remain the most effective way to prevent the spread of other sexually transmitted infections.”

The British groups’ pronouncement comes five years almost to the day after the Swiss Federal Commission for HIV/AIDS stated that heterosexual people with HIV cannot infect others if they are on successful ARVs, maintain an undetectable viral load and have no STIs. Many HIV advocates consider the BHIVA to be an especially cautious and conservative group, making its own bold statement about the matter all the more notable.

To read to position paper, click here.

Search: Expert Advisory Group on AIDS, EAGA, British HIV Association, BHIVA, transmission, treatment as prevention, antiretroviral therapy, ARV, sexually transmitted infections, undetectable viral load, serodiscordant couple, HPTN 052, Swiss Federal Commission for HIV/AIDS, U.K. Department of Health.


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