retries HIV prevention Upbeat findings presented last week at an international AIDS conference held in Rome complicated by the World health Organization (WHO) write much awaited guidelines for heterosexual couples where one partner is infected. WHO had planned to release some guidelines "discordant" in the works for several months, at the Rome meeting, but pulled the plug at the eleventh hour. "We were a little optimistic really get everything ready in terms of thinking about the operational implications," says Gottfried Hirnschall, director of HIV / AIDS Department of WHO.
Hirnschall said his group decided not to issue the guidelines because of urgings of "key partners", including the Joint United Nations Programme on HIV / AIDS and the Bill and Melinda Gates Foundation . In particular, the partners had concerns about the language in both the document and its lack of integration surprising news that appeared shortly before the Rome meeting.
Hirnschall says that a group of outside experts began a review of the evidence, the last year before making five recommendations for discordant couples. In mid-May, the group received its first surprise when a discordant couple during trial went public with early results because of the remarkable power of intervention: Known as HPTN 052 study showed that, if infected partner took antiretrovirals (ARVs), it reduces the risk of transmission by 96%. Hirnschall said the results did the group think long and hard about how to define a "couple" -be it cohabitation, marriage, or just a long-term relationship and logistical issues of how to oblige partners to submit to the tests and how to calculate the number of people worldwide would be eligible for this approach, called treatment as prevention.
News from a second study in serodiscordant couples, suddenly announced the week before the start of the meeting in Rome, said the project potentially more confusing instructions. The trial concluded that the treatment of uninfected partner with ARV-called pre-exposure prophylaxis (PrEP) -Reduced risk of transmission by 73%. The Partners PrEP study, as HPTN 052, published the results early because the intervention worked better than initially expected. "That's when we sat together and talked to our key partners and said," What should we do with the guidelines? "Explains Hirnschall" Is this really the best time to release the guidelines, or. we should take a deep breath and refine the definition and review the conclusions of the PrEP partners and probably release the guidelines a few months later? "
some participants in the Rome conference are concerned that WHO can refusing the document due to excessive pressure from partners on how much to emphasize PrEP against the treatment of the infected partner, who, in turn, raises questions about how best to invest limited resources . Hirnschall but insists that this is not the case. "Our decision was our decision but was informed feedback from a range of partners"
Meanwhile, in agreement with the rush of good news from the Rome meeting, the Foundation for AIDS research held a briefing in Washington tomorrow with the bold headline "Making History AIDS: ending the epidemic." participants will include Anthony Fauci (director of the National Institute of allergy and infectious diseases), Margaret Hamburg (head of the Food and Drug Administration), and Michel Kazatchkine (Executive Director of the global Fund to fight against AIDS, tuberculosis and malaria). the meeting plans to review the Partners PrEP and HPTN 052 data and also have an optimistic roadmap to bring the epidemic to a halt over the next few years.
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