AIDSWEEKLY Plus; Monday, February 15, 1999
Daniel J. DeNoon, Senior Editor

That's the urgent advice for people with HIV infection whose viral loads have dropped to undetectable levels due to highly active antiretroviral therapy (HAART).

Data collected by the U.S. Centers for Disease Control and Prevention (CDC) show no decrease in the incidence of HIV infection despite the advent of HAART.

"Even when persons on HAART achieve undetectable viral loads, we can't guarantee they won't transmit HIV," said CDC researcher Jonathan Kaplan. "All our safe-sex messages still apply."

Kaplan spoke in a symposium presentation to the 6th Conference on Retroviruses and Opportunistic Infections, held January 31-February 4, 1999, in Chicago, Illinois.

CDC studies suggest that many people whose HIV infections are being controlled by the drugs may think they can ignore safe-sex messages.

"There is some disturbing evidence from men who have sex with men that people on HAART may see themselves as less infectious and engage in increased high-risk behavior," Kaplan said. He noted that this misconception is very unlikely to be limited to gay men.

There are compelling reasons to think that HAART could reduce HIV transmission. Viral load does seem to be reduced, and even suboptimal antiretroviral therapy has been shown to reduce the risk of perinatal HIV transmission. Moreover, studies have shown that HAART decreases the amount of virus in genital secretions.

"The data are quite impressive and they suggest that transmission may be reduced," Kaplan admitted.

But as seems to be the case in all things relating to AIDS, the situation is not as simple as it appears.

Kaplan listed a variety of reasons why the HAART hasn't had an impact on AIDS transmission. He focussed on three:

• People are still transmitting the virus before they begin HAART regimens.
• HIV can be cultured from seminal fluids from patients whose plasma viral load has become undetectable due to HAART.
• As suggested above, risk behavior may be increasing among HAART recipients.

"We're probably not seeing a significant impact of these therapies on transmission in the U.S.," Kaplan concluded. "But this opens up a tremendous opportunity."

Because of the availability of HAART, patients may be motivated to seek care sooner after becoming infected. This not only offers an opportunity to reduce viral burden in potentially infectious individuals, but also offers new chances for counselling interventions to reduce transmission-risk behavior.

"HAART clearly is not indicated for all persons, and that, too, is a limitation," Kaplan noted. "We don't want to create the false impression that these drugs can reduce transmission."

990215
AW990212

Copyright © 1999 - Charles Henderson, Publisher. All rights Reserved. Permission to reproduce granted to AEGIS by Charles W. Henderson. Authorization to reproduce for personal use granted granted by C. W. Henderson, Publisher, provided that the fee of US$4.50 per copy, per page is paid directly to the Copyright Clearance Center, 27 Congress Street, Salem, Massachusetts 01970, USA. Published by Charles Henderson, Publisher. Editorial & Publishing Office: P.O. Box 5528, Atlanta, GA 30307-0528 / Telephone: (800) 633-4931; Subscription Office: P.O. Box 830409, Birmingham, AL 35283-0409 / FAX: (205) 995-1588 http://www.newsrx.net

Copyright ©1990, 2000. AEGiS & the Sisters of Saint Elizabeth of Hungary. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of ÆGIS, or the party credited as the provider of the content.