Newsday - Thursday, March 30, 2000
Laurie Garrett, Staff Writer

"What we found is that the level of HIV in an individual predicts their infectiousness," study director Dr. Thomas Quinn of the Johns Hopkins Medical Institute in Baltimore said in an interview. "If we can lower that level by whatever means, then we can lower the spread of the epidemic effectively." The high cost of drugs that can lower HIV levels generally puts them out of reach in African nations where AIDS is a pandemic.

This study, done in collaboration with Dr. David Serwada's team at Makerere University in Kampala, Uganda, is a landmark, experts say, because it is the first to follow over time married couples in which one partner was HIV positive, the other HIV negative. The couples, in the rural Rakai District of Uganda, were not only monitored but also aggressively treated for other sexually transmitted diseases, such as syphilis, and given free condoms.

Earlier studies conducted both in Africa and the United States had indicated that other factors-chiefly, lack of male circumcision and the presence of other sexually transmitted diseases-played key roles in making sex partners vulnerable to HIV infection. But this new study, details of which appear in today's New England Journal of Medicine, shows that the influence of those factors pales when compared with the level of virus in the blood.

"For every 10-fold rise in the concentration of HIV in the bloodstream, transmission more than doubled," Quinn said.

At the National Institute of Allergy and Infectious Diseases, director Dr. Anthony Fauci said, "The findings uphold the strategic benefit of lowering levels of HIV in the blood...[to] help reduce heterosexual transmission of HIV, the predominant way AIDS is spreading in Africa and many parts of the world." But the cost of the so-called drug cocktails used in the United States averages more than $20,000 a year for the medicines and accompanying care.

In an editorial in today's New England Journal of Medicine, Dr. Marcia Angell-editor of the Journal of the Medical Association-attacks the study, accusing the researchers of unethical behavior. Angell argues that the sorts of drug cocktails used in the United States should have been provided by the researchers to the Ugandan couples-or else, she says, the study should not have been done. "Our ethical standards should not depend on where the research is performed," she said.

But the study, Quinn insists, was designed to test the hypothesis that aggressive treatment of other sexually transmitted diseases - not of HIV - would lower the risk of transmission of the AIDS virus. All study participants got state-of-the-art treatment for sexually transmitted diseases.

To address the situation, Quinn said, "we should be talking to pharmaceutical companies now to promote development of affordable drugs ... and that's going to take a concerted effort.

Anything that even slightly lowers the levels of HIV in the blood or genitals of infected individuals could have dramatic public health benefits, he argues.

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