An ongoing dialogue on HIV/AIDS, infectious diseases,
May 5th, 2019
Latest Published Study on HIV Treatment as Prevention Is Déjà Vu All Over Again, But Some News Is So Good It Never Gets Old
Even if you’re not an ID or HIV specialist, there’s an excellent chance you’ve heard of the PARTNER2 study, just published in The Lancet.
If not, the title could not be more descriptive:
Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy
And, in case you’ve just awoken from a
Rumpelstiltskin Rip Van Winkle-length sleep, here are the results:
The risk is essentially zero.
The formal publication of PARTNER2 therefore has a déjà vu quality to it, one which prompted Myles Helfand, the indefatigable and entertaining Executive Editor of the terrific HIV resource TheBody, to post the following:
Breaking: A fact we've already known conclusively for about three years https://t.co/YYML1z8igh
— Myles Helfand (@MylesatTheBody) May 3, 2019
“Breaking” indeed. Ha. To Myles, and to many of us, this is old news. The publication of the paper after years of comparable findings from this and other studies may seem anticlimactic, no big deal.
He’d no doubt cite that even this particular study was presented first at the AIDS 2018 conference last summer in Amsterdam. That’s over 8 months ago! Ancient history!
But here’s another take from Claire Farel, an ID doctor from the University of North Carolina (and, full disclosure, a wonderful graduate of our ID fellowship program):
Another boost to our conviction that #UequalsU and hopefully to the fight against #HIV stigma. Discussing U=U with patients has been a gift, leading to some of the most profound conversations I’ve had in medicine. Also, there’s never enough Kleenex. https://t.co/jC7iMhSQZ8
— Claire Farel (@claire_farel) May 3, 2019
(For those not in our field, that “U=U” stands for “Undetectable = untransmittable.”)
First, I am in complete agreement that telling people with HIV that their treatment prevents viral transmission is a “gift,” leading to profound and anxiety-relieving responses. It’s just as good as informing patients that if they take their HIV meds, they will not die of AIDS — and both pieces of information are equally true.
Conveying this information elicits such relief that yes, tears of happiness are often part of the mix, if you’re wondering about that Kleenex reference.
Second, the publication of a study in a peer-reviewed journal still lends far greater authenticity to scientific data than conference presentations or abstracts. This is particularly true when the journal publishing the paper is a prestigious one, such as The Lancet.
(I have cleared it with the Editorial Office that we’re allowed here at NEJM Journal Watch to write that The Lancet is prestigious. Note I didn’t say MOST prestigious.)
Don’t get me wrong — I agree that conference presentations play a critical role in rapidly getting important new data into the public domain. But there’s still room for distribution the old-fashioned way, in a journal, which is why I posted both Myles’s and Claire’s responses to this publication.
Before we leave this study, we must linger for a moment on the most unintentionally amusing sentence from PARTNER2.
In total, couples reported having condomless anal sex approximately 76,088 times during eligible couple-years of follow-up.
Something about the precision of that estimate — are they sure it wasn’t 76,089? — makes me smile every time.