Love Your Mate, Not AIDS

HIV serodiscordant couples treated with antiretroviral drugs could be a cost effective prevention

(RxWiki News) If your long-term partner has HIV, you're at a high risk for infection. But medical research is creating options to safeguard yourself and your partner against transmitting the virus.

A HIV serodiscordant couple is a couple in a long-term relationship in which one partner is HIV-positive and the other partner is HIV-negative. Such couples may not always practice safe sex, especially if they want to have children.

Preventing HIV transmission within the relationship is a priority for doctors, and a new study finds that providing both partners with antiretroviral drugs could be a cost-effective way to keep the uninfected partner from becoming infected.

"If your partner has HIV, see your doctor."

In sub-Saharan Africa, 10 – 20 percent of couples are serodiscordant. Most new HIV infections occur in this region, and condom use is low. HIV is typically transmitted by unprotected sex with an infected partner. As of yet, there is no vaccine that prevents against HIV infection.

Fortunately, antiretroviral drugs (ART) have proven increasingly effective in keeping the virus in check among those who are infected. Doctors also use the strategy of giving these drugs to people not yet infected with HIV to reduce the risk of acquiring the disease. This strategy is called preexposure prophylaxis (PrEP). It has had some success in clinical trials.

A new study published in PloS Medicine, led by Timothy Hallett of the Department of Infectious Disease Epidemiology at Imperial College London, looked at how different strategies might affect transmission in serodiscordant couples. The research team used a mathematical model to determine the long-term impact and cost-effectiveness of these strategies in HIV prevention.

The model incorporated data including pregnancies, frequency of sex, contact with other sexual partners, as well as disease progression, ART use, and estimates of PrEP effectiveness from clinical trials.

The researchers found that to keep couples alive, healthy, and prevent transmission, it could be as cost-effective to provide PrEP to the uninfected partner as it would be to begin ART therapy earlier in the infected partner. The most cost-effective strategy, according to the study model, would be to begin PrEP in the uninfected partner before the infected partner started ART.

People with HIV are currently advised to start ART when an immune cell called CD4 drops below a certain a level. These strategies are suggesting that the infected partner start the treatment earlier than currently advised.

The study authors say their findings suggest that PrEP – having an uninfected, but at-risk person take antiretroviral drugs daily – might become a cost-effective prevention option along with condoms and male circumcision programs.

The study was published in PloS Medicine in November 2011.

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Review Date: 
November 16, 2011