An end to the AIDS epidemic might be nearer after a landmark study found that men whose HIV infection was fully suppressed by anti-retroviral drugs such as PrEP had no chance of infecting their partner.
The study, published in the medical journal, “The Lancet,” considered transmission rates from 1,000 male couples in Europe where one of the partners was HIV negative and the other was HIV positive and receiving treatment to suppress the virus.
The study, led by professor Alison Rodger (University College London Institute for Global Health), found no cases where HIV was transmitted to the HIV-negative partner during unprotected sex. Over the eight-year study, 15 men were infected with HIV, but researchers found this occurred only when the HIV-negative person had sex with a person other than his partner who was not being treated.
The virus of the newly-infected men were screened, and none were genetically linked to the HIV virus that had infected their primary partners, ruling out any within-couple HIV transmissions.
Researchers estimate that effective anti-retroviral therapy prevented about 472 HIV transmissions during the eight years of the study.
Rodger reportedly said that if everyone knew their HIV status and had access to effective treatment, no new cases of HIV would occur, based on the study results; if the treatment were available globally, the virus could be eliminated.
This news is especially promising for cities like Philadelphia, where transmission rates are higher than New York City, Los Angeles and San Francisco. The latest studies, released this year, put Philadelphia among the top cities for HIV transmission. According to the Philadelphia Department of Public Health, Philadelphia’s HIV infection rate is five times the national average.
“Obviously, any news of an end to the HIV epidemic is fantastic for those of us who have been living and working in its shadow for decades,” said Greg Herren, who works as an HIV-prevention specialist. “I am cautiously optimistic we will see the end of this in our lifetimes.”
Mazzoni Center’s Dr. Marcus Sandling echoed Herren and said that the study provides hope, though he added that those with socialized medicine are better prepared to implement what would be required to stop HIV transmission.
Sandling noted that a few years ago, a heat map done of HIV/AIDS cases found people in urban areas and minorities were most impacted. Subsequent studies, Sandling explained, showed that “HIV acquisition was highest among minority gay and trans people of color.”
Sandling said that limited medical care and a lack of medical insurance are the major obstacles to getting the kind of treatment necessary. He also noted that in rural areas of Pennsylvania and other states, access to care for HIV/AIDS is more severely limited than in cities.
Mazzoni has a PrEP clinic “especially tailored for the communities most at risk,” but Sandling said, getting people into those programs is the problem. “From a science perspective,” he said, “to protect the majority of people, you’d need to put it [HIV-prevention treatment] in the water like fluoride. Then it’s a disease that you could theoretically stop.”
Jane Shull, CEO of Philadelphia Fight, spoke at length to PGN about the study, its import and what it means going forward. Shull was blunt: The prohibitive cost of PrEP is an issue and so is managing a transient client base that has grown exponentially with the opioid crisis and resurgence of IV drug infections.
Shull said Philadelphians who have sex for survival or sex for drugs don’t have access to drugs like PrEP, which costs about $2,000 a month.
“We’ve known for a while that we could stop transmission. But the cost — paying for the drugs for the people who need it — that translates to political will. We don’t have that. Yet, there are a lot of people who need this. If you treated everyone, you could stop transmission.”
Shull notes that distributing PrEP to the people most in need of it is “something we just don’t know how to do right now.”
At Philadelphia Fight, concerns over how the opioid epidemic is adding to HIV transmission are paramount. Shull said that the agency hadn’t seen such an increase in the number of deaths from overdoses or the number of new infections since before 1996.
“Internationally, there is treatment on demand,” she explained, “and yet in this country, there is no such thing.” Deaths — unnecessary deaths — are the result.
“We have a very hard time in this country seeing these people [IV-drug users and people with HIV/AIDS] as our neighbors, our friends and our family members,” Shull said. “It took a new epidemic that is largely white to even draw attention to these issues. HIV is a medical condition, not a moral condition.”
Of Rodger’s study Sandling said, “I am still hopeful that we can make progress. But if you have a cure for cancer and people can’t get access to it, then who is being cured?”
Dr. Mervyn Silverman led the San Francisco Department of Public Health in the Eighties during the AIDS epidemic in San Francisco. He puts the study in perspective.
“This suppressed the disease to such a low level that the person is not infectious anymore,” Silverman said. “Now, what is so important is getting everybody tested. Those who are positive — getting them under treatment, maintaining that treatment and people adhering to the medication on a daily basis.”
But as Shull and Sandling note, in the United States — and especially in Philadelphia — how to do that is the elusive next step in the battle against HIV.