October 1, 2007

ART, Circumcision, STI Treatment as HIV Prevention

Thomas QuinnThere is growing evidence to confirm what many already suspected: antiretroviral therapy (ART) significantly decreases the likelihood of HIV transmission from HIV-positive individuals to their HIV-negative partners. That was one of the promising findings on HIV prevention that Tom Quinn, MD, FIDSA, of Johns Hopkins University presented in his John F. Enders Lecture at the 45th Annual Meeting of IDSA, in San Diego. Dr. Quinn also highlighted evidence on the benefits of circumcision, and of treating sexually transmitted infections (STI), particularly herpes.

Dr. Quinn, who is also affiliated with the National Institute of Allergy and Infectious Diseases,  reviewed data presented at last year’s International AIDS Society (IAS) conference from the Rwanda Zambia HIV Research Group that demonstrated ART’s protective effect on HIV-negative partners in serodiscordant relationships. The study enrolled 1,034 serodiscordant couples in which the HIV-infected partners had a CD4 count < 200cells/mL and/or had advanced or severe symptoms by the World Health Organization classification. In 248 of these couples, the HIV-positive individual was on ART. Of the 42 seroconversions during the study period, only two were individuals whose partners were on ART.

Dr. Quinn also recapped a study from IAS 2007 in which 557 pregnant women received a three-drug ART regimen and were given the option before delivery to breastfeed or formula-feed. Breastfeeding mothers continued ART during the six months of breastfeeding and one month after. Half formula-fed their babies and 43 percent breastfed. Overall, six children (1.4 percent) were infected at birth and only one child was infected from breastfeeding.

HSV-2 and HIV

Dr. Quinn also spoke of the relationship between STIs and HIV transmission and acquisition. In particular, there seems to be a positive association between herpes simplex virus 2 (HSV-2) infection and HIV acquisition. A study demonstrated that those with HSV-2 were 1.7 times more likely to acquire HIV infection than those without HSV-2. Dr. Quinn added that acyclovir and valcyclovir for the treatment of HSV-2 is being studied as an effective way to reduce HIV acquisition in several populations.


Studies from Uganda, Kenya, and South Africa show male circumcision reduces HIV acquisition by 60 to 70 percent. Based on these results, the World Health Organization and the United Nations Programme on HIV/AIDS issued a statement in March regarding the efficacy of male circumcision in reducing female-to-male HIV transmission. Scaling up male circumcision in many countries would have an immediate effect, Dr. Quinn suggested. “No other piece of the body has the same amount of susceptible target cells,” he added.

Dr. Quinn concluded by emphasizing the importance of coupling circumcision and other biomedical interventions with behavioral ones. “Let me emphasize that [circumcision] needs to be integrated with behavioral interventions,” he said. “Otherwise the protective effect of circumcision could be abrogated completely if men increase risky sex activities.”

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