via AIDSmeds, by Tim Horn


A key question from HPTN 052 is whether the results can be generalized to other contexts, Cohen and his colleagues explain. Examples include heterosexual couples with CD4 counts lower and higher than those studied in HPTN 052; high-risk heterosexual individuals, notably sex workers and their clients; men who have sex with men (MSM); and injection drug users (IDUs).
With regards to MSM and IDUs, the authors note, a World Health Organization expert committee concluded that there is no reason to presume that treated, HIV-positive MSM will not be rendered less contagious as a result of ARV therapy. “However,” Cohen and his colleagues write, “the biology of HIV transmission is sufficiently different in IDU and MSM as compared to heterosexual transmission, warranting further consideration and study.

“For example, the number of HIV variants acquired and the efficiency of transmission are higher in MSM and IDU than in heterosexual transmission,” they note in recalling one study. “Additionally, whether [ARV therapy] reduces infectivity through anal sex by the same order of magnitude as for vaginal sex remains uncertain. Although such an effect is widely assumed, this is a key missing piece of evidence.”

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