>> Study finds zero HIV transmissions when partner on treatment has undetectable viral load
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Selon une étude de grande envergure, menée avec une équipe de chercheurs aux Etats-Unis, les antirétroviraux réduisent le risque de transmission du virus du sida dans les couples où l’un des partenaires est séropositif et qui ont des rapports sexuels sans préservatif.
Sur quelque 900 couples, dont les deux tiers étaient hétérosexuels (62%) et un tiers homosexuel (38%), suivis pendant 1,3 année en moyenne sur 75 sites cliniques dans 14 pays européens entre septembre 2010 et mai 2014, aucun cas de transmission du virus n’a en effet été détecté entre ces partenaires, d’après les travaux publiés ce mardi dans le Journal of the American Medical Association (JAMA). Par contre, sur les 129 personnes séronégatives qui ont dit avoir eu des relations sans préservatif hors de leur couple, onze ont été contaminées.
« Cette étude fournit des informations utiles pour mieux comprendre et apprécier le risque lié à ce virus pour les couples séro-différents ayant des rapports sexuels non-protégés, surtout pour les hétérosexuels », écrivent les chercheurs. Mais ils estiment qu’un suivi plus long est nécessaire pour procurer un niveau similaire de confiance ou d’appréciation du risque pour les rapports anaux. De ce fait, les couples homosexuels dans l’étude seront suivis pendant encore trois ans.
Les personnes séropositives qui ont participé à l’enquête, traitées avec des antirétroviraux, ont en outre réduit leur charge virale à moins de 200 copies/ml, soit une infection quasiment indétectable.
« Les résultats de cette étude montrent clairement qu’un diagnostic précoce d’infection par le VIH et l’accès à un traitement efficace sont cruciaux pour réduire le nombre de nouveaux cas de VIH », souligne le professeur Jens Lundgren du Rigshospitalet, à l’université de Copenhague, l’un des principaux auteurs. « Dès qu’une personne infectée supprime sa charge virale avec des antirétroviraux, le risque de transmission devient minimum », ajoute-t-il.
Pendant la période de suivi, les couples ont fait part de 37 rapports annuels non-protégés en moyenne.
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>> A new study has found zero cases of HIV transmission between sero-discordant partners where the partner with HIV has an undetectable viral load.
The PARTNER study, which included 1,166 serodifferent couples at 75 clinical sites in 14 European countries, has been released in time for the International AIDS Conference 2016 in Durban, South Africa.
Researchers say their subject couples had sex up to 58,000 times in all with no HIV infection linked to them.
Nicolas Parkhill, CEO of the AIDS Council of NSW, said the PARTNER study will go some way in breaking down the stigma surrounding HIV that still unfortunately permeates our community.
« The evidence has been building for a while now that an undetectable viral load is an effective means by which HIV transmission can be prevented and this study can only now confirm that messaging, » Parkhill told GNN.
« This result emphasises the importance of early and continued treatment, along with other prevention strategies such as condoms and PrEP, in virtually eliminating new HIV notifications by 2020. »
Craig Cooper of Positive Life NSW also welcome the results of the study.
« People with HIV welcome the latest results from the PARTNER study published in the Journal of the American Medical Association. These results contribute to a growing body of evidence, which further reduces the anxiety and fear that people with HIV have about transmitting the virus to their HIV-negative lovers and fuck buddies. By decreasing shame associated with HIV, this will directly impact on HIV stigma, » Cooper said.
Although 11 people became HIV positive during the study, none of these infections were linked to the positive partner. Most people reported having sex without condoms with people outside the main relationship.
Researchers say the study indicates there may truly be zero risk of transmitting HIV where the person living with HIV is on anti-retroviral therapy and has an undetectable viral load, which justifies current Treatment as Prevention strategies.
« Over the past few years, treatment as prevention has been increasingly shown to be a very real means by which transmission of the virus can be seriously reduced, and the results of the PARTNER study will play a significant role in the continued promotion of early and continued treatment of people living with HIV within sero-discordant relationships, » Parkhill said.
« The results reinforce that there are now a variety of prevention strategies both positive and negative people can employ in our shared responsibility towards ending HIV. »
Cooper agrees. « The study provides us with evidence that suppressed virus through anti-retroviral treatment prevents HIV transmission in MSM and heterosexual sero-different couples who are having condomless sex. The study has shown no documented cases of within-couple HIV transmission. »
« The study investigators caution that additional longer-term follow-up is needed to provide a precise estimate of risk, » Cooper added.
Researchers have said the results should also be a wake-up call to those who would continue to treat HIV transmission as a criminal offence.
« HIV in Australia is a manageable chronic condition, one that is no longer fatal if treated, » Parkhill agreed.
« The outcomes of the PARTNER Study reinforces that treatment is also an extremely effective means of HIV prevention within sero-discordant relationships, giving further weight to the belief that HIV should be dealt with as a public health matter rather than a criminal one. »
« We need to ensure that people are not criminalised based on their HIV status, and that the law reflects mutual responsibility, placing the onus on each individual to consider and negotiate sexual and injecting practices. »
