New BHIVA guidelines recommend discussion with all patients on potential of HIV treatment to protect sexual partners
The British HIV Association today recommends that doctors
should discuss the evidence for the effectiveness of antiretroviral treatment as
prevention with all patients with HIV, and that it should be offered those who
want to protect their partners from the risk of HIV infection – even if they
have no immediate clinical need for treatment themselves.
Evidence from a large trial of the effects of earlier
antiretroviral treatment on HIV transmission to partners has convinced UK
doctors that treatment should be offered in circumstances where patients are
concerned about the risk of transmitting HIV to partners – even if they are not
in a serodiscordant relationship at the time.
All patients should be informed of this evidence, the
guidelines say, but no patient should be forced to take treatment for this
Patients should also be told that the evidence of a lower
risk of transmission on treatment mainly relates to vaginal and not anal sex,
and that use of condoms will continue to protect against sexually transmitted
infections as well as lowering any residual risk of HIV transmission.
The recommendation forms part of new adult antiretroviral
treatment guidelines for the United
Kingdom issued for consultation this week.
However, after rigorous review of the published evidence
British doctors have concluded that the UK will stick with a CD4 cell count
of 350 cells as the threshold for starting treatment in the majority of
In contrast United
States guidelines recommend treatment in
patients with CD4 counts up to 500 cells, though noting the absence of evidence
from randomised trials to support this guidance.
The new guidelines also make a clear recommendation on the
two nucleoside drugs that should be used as the basis of first-line
antiretroviral treatment. The guidelines committee has concluded that the
balance of evidence favours tenofovir and emtricitabine (FTC) as the preferred
option for patients in the UK.