Intensive Therapy May Slash Number of New HIV MSM Infections

Marcia Frellick

January 06, 2016

Researchers studying Dutch men who have sex with men (MSM) who were newly infected with HIV found that more frequent testing followed by treatment with available antiretroviral therapy (ART) may cut infections by 66%.

New HIV diagnoses among MSM have stayed relatively stable in most countries, even though care and prevention services have been scaled up substantially in the last 20 years. Oliver Ratmann, PhD, from the Department of Infectious Disease Epidemiology in the School of Public Health at Imperial College London in the United Kingdom, and colleagues wanted to find out why.

They used viral sequence and clinical patient data from one of Europe's nationwide cohort studies to estimate the probable source of the transmission to 617 MSM in the Netherlands. They found that 71% of transmissions were from undiagnosed men, 22% from diagnosed but not yet treated men, 6% from men who had started ART, and 1% from men with no link to care for at least 18 months. Some 43% of transmissions were from men in their first year of infection. The researchers conclude that the lack of decline in new HIV cases among MSM was not coming from ineffective ART provision or inadequate retention in care.

Their findings were published online January 6 in Science Translational Medicine.

Using modeling scenarios, the authors found that 19% of past cases could have been averted with current annual testing and immediate ART provided to those who tested positive. Sixty-six percent of these cases could have been averted with available ART provided to all MSM testing positive and by preexposure antiretroviral prophylaxis taken by half of all patients who test negative for HIV (only if half of all men at risk for transmission had tested annually).

The editor's summary included in the article concludes that, "These findings support making ART for pre-exposure prophylaxis available worldwide, and especially in countries with high retention in care and high ART coverage among infected MSM."

The 2016 World Health Organization guidelines now recommend ART initiation regardless of CD4 cell count after diagnosis, as well as provision of ART as preexposure prophylaxis for those at substantial risk for infection.

The study is supported by the Wellcome Trust, the European Research Council, and the Bill & Melinda Gates Foundation. The ATHENA observational cohort study is part of Stichting HIV Monitoring and is supported by a grant from the Netherlands Ministry of Health, Welfare and Sport through its Centre for Infectious Disease Control–National Institute for Public Health and the Environment. One coauthor received independent scientific grant support from Bristol-Myers Squibb, ViiV Healthcare, Gilead Sciences, Janssen Pharmaceuticals Inc, and Merck & Co through his institution; served on a scientific advisory board for Gilead Sciences; and serves on a data safety monitoring committee for Janssen Pharmaceuticals Inc, for which his institution has received remuneration. The other authors have disclosed no relevant financial relationships.

Sci Transl Med. Published online January 6, 2016. Abstract

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