October 30th, 2013

HIV Treatment of Serodiscordant Couples: The Home Run, Slam Dunk, and Open Goal in Clinical Research

Just in time for Game 6 of the World Series, my colleague Rochelle Walensky has published a paper in theNew England Journal of Medicine (covered here in NEJM Journal Watch). evaluating the cost-effectiveness of treating HIV-infected individuals in serodiscordant couples.

The results:

In South Africa, early ART was cost-saving over a 5-year period. In both South Africa and India, early ART was projected to be very cost-effective over a lifetime. With individual, public health, and economic benefits, there is a compelling case for early ART for serodiscordant couples in resource-limited settings.

I added the bolding, because in the cautious and scientific style of NEJM, you’re not allowed to do this, but it’s worth emphasizing the main point — everyone with HIV in a serodiscordant couple should be on HIV treatment, regardless of CD4 cell count.

Every so often, a research paper comes up with results that are so staggeringly TRUE that one wonders, what was the controversy? And this is one of them. Take a look at this randomized clinical trial of fecal transplant for relapsing C. diff for a non-HIV example. Or this one on the effect of H. flu immunization in children.

It’s incredibly satisfying, which is why the sports metaphors in the title come to mind.

In fact, when the senior author on the paper, Ken Freedberg, presented these data at the International AIDS Conference in Washington DC in 2012, he was asked by someone in the audience whether he thought the results should “influence policy.”

Like the slugger seeing a pitch right down the middle, the point guard stealing the ball in the backcourt, or the soccer forward beating the goalie who has come out of position, Ken salivated at the chance to answer this question, then, predictably, hit it out of the park. (Or whatever your favorite sport is.)

I don’t remember his exact words, so Carlton Fisk will have to do the talking:

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HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

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