Treat Gay Swiss at Diagnosis?
posted: 19/04/2010
Swiss researchers are now suggesting that all HIV positive gay / bi men should be offered HIV treatment straight after diagnosis, to control the Swiss HIV epidemic among gay and bi men. They found that most new HIV infections amongst gay men in Switzerland came from men who have had HIV for some time, and all of these men had stopped taking treatments. In this Swiss study, HIV rarely came from newly infected men.
Treat to prevent
The investigators believe that their findings support “early” and “continuous” use of HIV treatment by gay men, and suggest that this could profoundly slow the HIV epidemic in this population.
We think the Swiss should concentrate instead on finding out why these men have stopped taking treatments and are having unprotected sex, and deal with those.
Treating everyone at diagnosis would help cut the numbers of new infections, but men with HIV have every right to choose whether to take anti-HIV treatment. No one has the right to force HIV treatment on people, even if this will help reduce the number of people getting HIV.
The UK national treatment guidelines advise people to start HIV treatment when it is best for that individual with HIV, not as a normal means of HIV prevention to protect others.
Infection clusters
An in-depth knowledge of the dynamics of HIV transmission among gay men helps us plan effective prevention campaigns. Swiss investigators (using the Zurich Primary Infection study and the Swiss HIV Cohort study) used phylogenetic analysis to discover clusters of closely related-HIV transmissions among recently infected gay men.
Stopped treatment
They mapped the clusters of HIV transmissions amongst gay men recently infected with HIV. They found only two men whose HIV came from men who had only just got HIV themselves. Almost every Swiss man’s infection came from a guy who had HIV for at least one year, and it was always from a man who had stopped taking HIV treatment. “Infectiousness during chronic infection was quite high in this population”, comment the investigators.
They found identified six transmission clusters involving 20 men from the Zurich cohort and eight individuals from the wider Swiss cohort. Only two infections appeared to originate in individuals with very recent HIV infection. The rest had their source in chronically-infected individuals who had stopped taking HIV treatments. These men had viral loads ranging from 314 – 1,690,000 copies/ml.
The investigator’s first analysis suggested that one man who was taking HIV therapy and had an undetectable viral load may have transmitted HIV to his partner. However, further genetic analysis found three other patients with more closely matched virus – one of whom was the source of the HIV.
“We detected a remarkable proportion of new infections originating from … patients …. already in their chronic phase”, comment the investigators. They add, “These findings argue strongly for early, continuous antiretroviral therapy in sexually active HIV-infected men who have sex with men. This strategy, most likely, will have a profound impact to reduce further spread of HIV.”
George House Trust comment
The Swiss authors don't explain how treating every gay / bi man with HIV will work when almost all Swiss the infections in this study come from men who have chosen to stop taking their treatment. It is wrong to force treatment on people.
We think it makes far more sense for the Swiss to understand why these men
- stopped taking all HIV treatment
- are having unprotected sex
and then to provide better treatment and prevention support.
Local solutions for each local epidemic
Treating every gay and bi man with HIV might just be the solution for the gay / bi HIV epidemic in Switzerland, but it is not likely to be the best solution for England. For example in England we know that a significant proportion of new gay / bi HIV infections come from men who were just infected themselves.
Source with reference
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