Early H.I.V. Therapy Sharply Curbs Transmission

 

Patients with H.I.V. were 96 percent less likely to pass on the infection if they were taking antiretroviral drugs — a finding that is so overwhelming that it is likely to change the way American AIDS doctors treat patients and what treatment policies are adopted by the World Health Organization and other countries, said Dr. Anthony S. Fauci, head of the National Institute of Allergy and Infectious Diseases, which paid for the trial.

The data was so convincing that the trial, scheduled to last until 2015, is effectively being ended early.

There have been previous studies, notably among drug abusers in San Francisco and Vancouver, British Columbia, that concluded that starting patients on drugs immediately would stop them from infecting others.

Those studies led Unaids, the United Nations AIDS-fighting agency, to adopt “test and treat” as its goal last year; the policy encourages doctors to start people on treatment as soon as they test positive for H.I.V. However, this is the first evidence from a randomized clinical trial, the gold standard in medical research.

AIDS prevention specialists not connected to the trial were enthusiastic.

“These results are phenomenal,” said Thomas J. Coates, director of the global health program at the University of California, Los Angeles, and the founder of the Center for AIDS Prevention Studies in San Francisco. “It was a tough study to do, and I’m thrilled it came out this way.”

Dr. Julio Montaner, an AIDS specialist at the University of British Columbia whose work among Vancouver heroin addicts helped lead to the Unaids policy, called the result of 96 percent protection “as good as it gets.”

“This is consistent with what we’ve been saying and doing in British Columbia for close to a decade,” he said. “How much more evidence do we need before we implement what we know works?”

The $73 million trial, known as HPTN 052, involved 1,763 couples in 13 cities on four continents. One member of each couple was infected with H.I.V.; the other was not. In half the couples, chosen at random, the infected partner was put on antiretroviral drugs as soon as he or she tested positive for the virus.

In the other half, the infected person started treatment only when his or her CD4 count — a measure of the immune system’s strength — dropped below 250 per cubic millimeter.

In 28 of the couples, the uninfected person became infected with the partner’s strain of the virus. Twenty-seven of those 28 infections took place in couples in which the partner who was infected first was not yet getting treatment.

On Thursday, Dr. Fauci and Dr. Myron Cohen, an AIDS specialist from the University of North Carolina at Chapel Hill and the study’s director, announced that the data collected since the study began in 2005 had been “unblinded” to an independent safety review panel, which is standard procedure in clinical trials. When the panel realized how much protection early treatment afforded, it recommended that drug regimens be offered to all participants. Although participants will still be followed, the trial is effectively over because it will no longer be a comparison between two groups on different regimens.

The results carry moral implications for doctors in the United States. Although medical associations like the Infectious Diseases Society of America advocate starting patients on AIDS drugs early, the decision is made by the doctor and patient. Some patients fear the reported side effects of AIDS drugs and want to delay taking the drugs until they get obviously sick or until their CD4 counts fall, and some doctors go along with that, Dr. Fauci said, especially as long as their patients’ CD4 counts remain above 350.

But that means the patient may infect others during the delay. Of the 27 people in the study who became infected while their partners were not yet taking the drugs, 17 had partners whose CD4 counts were still above 350.

Asked if it could now be considered immoral for a doctor to accede to a patient’s request to delay starting drugs, Dr. Fauci said: “I’m not going to go there. I’m not going to say it’s immoral. But there is more and more data showing the advantages of starting as early as you can.”

Dr. Coates of U.C.L.A. said he hoped that treatment delays would fade away because the newest antiretroviral drugs had few side effects.

Although the evidence suggests that it would be good public health policy to lower infection rates by starting everyone on drugs as soon as they are infected, that is impossible in much of the world. For lack of money, clinics in Africa are turning away patients who are not just infected but close to death. And in some American states where money provided by the Ryan White Care Act has run out, poor uninsured people are on waiting lists.

Although the trial was relatively large, there are some limitations on interpreting the data.

More than 90 percent of the couples in the trial, who lived in Botswana, Brazil, India, Kenya, Malawi, South Africa, Thailand, the United States and Zimbabwe, were heterosexual.

“We would have liked to have a substantial number of men as potential study subjects, but they just weren’t interested,” Dr. Cohen said.

Although common sense suggests the results would be similar in the contexts of homosexual sex and sex between people who are not couples, strictly speaking, the results apply only to the type of people studied, Dr. Fauci said.

 

Friendster to Erase Early Posts and Old Photos

Friendster, which started in 2003, has long been eclipsed by younger, more nimble rivals, turning into something of a ghost town. But on Tuesday, its current owners told users of plans to change its business strategy — and to wipe out the site’s trove of digital memories, including ancient dorm-room photos, late-night blog entries and heartfelt friend endorsements, known as “testimonials.”

That set off a wave of nostalgia among Friendster members, even though most had stopped visiting the site long ago.

Jim Leija, 31, who works at a nonprofit music organization in Ann Arbor, Mich., recalled courting his partner, Aric Knuth, through the site.

“All of our early exchanges were with each other through their messaging systems,” he said. “We were writing early love notes back in the winter of 2003.”

Mr. Leija said that even though he had not used the service in three or four years, the news of its plans to erase older material tugged at his heartstrings. “Your emotions get wrapped up in it,” he said. “It reflected a particular moment in time in our lives.”

The mass deletion of so much evidence of embarrassing wardrobe choices and unrequited crushes might come as a relief to some, especially in an era when it seems that everything uploaded to Facebook can haunt people forever. But some say Friendster has unexpectedly turned into a time capsule with snapshots of who they once were. It is a version of their history that is not in a scrapbook or dusty shoebox but is live on the Web — for now.

“We want to forget our misdeeds and bad choices, but we also kind of want to remember them,” said Danah Boyd, a social media researcher at Microsoft and a fellow at Harvard University’s Berkman Center for Internet and Society. “These old networks are our memories.”

Joanne McNeil, who studies and writes about Internet culture, said that as more of life is lived on the Web, people become more emotionally invested in the presence of particular online services, even those they have abandoned.

Ms. McNeil added that the realization that years of history could be deleted on a corporate whim was jarring.

“The impermanence of the Web used to be a way of life,” she said. “A site could be gone in weeks, months. But Google and Gmail came along and changed that, and now we always expect to have a copy of our lives online.”

Friendster’s plans to strip the service of older material reminded some of Yahoo’s move in April 2009 to pull the plug on GeoCities, an early provider of free Web home pages. At the time, Internet tinkerers and historians worked to keep the site’s millions of pages from disappearing forever. Jason Scott is the founder of a group called the Archive Team that tries to save such online content. He recently rallied efforts to preserve clips from Google Video, which Google is shutting down in favor of the more popular YouTube.

Mr. Scott said that the shuttering of social Web services and online communities was a “critical cultural issue.”

“This is the everyday neural activity of a world, of a society, scooped up and saved,” he said. “To me, that’s completely valuable and worthwhile to make sure it is saved for the future.”

Mr. Scott said his group planned to try to download as much of Friendster’s public data as possible before it is erased at the end of May, and to make it available online in some form.

Friendster’s current owner, MOL Global of Malaysia, said the site’s basic profile information and lists of friends would remain intact as it becomes more of an entertainment site. It is offering ways for members to download threatened photos and other material.

Friendster was once considered a hot property. The site’s financial backers included Peter Thiel, a co-founder of PayPal, and K. Ram Shriram, one of the first investors in Google. In fact, Google offered to buy Friendster for $30 million in 2003, but the site’s founder, Jonathan Abrams, chose to keep it independent. When MOL Global bought it in late 2009 for an undisclosed sum, it said the site had more than 115 million members, though it was not clear how many of those were active.

Reached by phone on Tuesday, Mr. Abrams said he had not yet heard of the planned changes to the site. And he said he was surprised that anyone would care.

“It’s so old news to me,” said Mr. Abrams, who is involved in projects including a work space for start-ups and a social media venture. “After it was bought by the Malaysian company, that was the final chapter.”

 

Peugeot and Renault to Repay Government Loans Early

The French industry minister, éric Besson, told ?France Info radio that the remainder of the 6 billion euros, or $8.7 billion, owed would be repaid “in the next few days,” which was “faster than anticipated.”

The decision, he said, showed that “confidence has returned” to the ?sector.

In 2009, amid plummeting sales and the prospect of large layoffs, the French government announced that it would lend Peugeot ?and Renault $4.4 billion each over five years at 6 percent interest. Renault Trucks, now owned by Volvo, also received aid.

In conjunction, the automakers introduced part-time work arrangements and curbed production at some plants.

Since then, the health of the two companies has slowly improved. The turnaround was helped initially ?by government incentives for buyers that lifted sales in Europe but have now expired. Sales were also robust in emerging markets like Brazil, China and Russia. ?

A report this week from the European Automobile Manufacturers’ Association,, showed new passenger car sales in the European Union fell 5 percent in March from the period a year earlier. Sales in Germany and France both grew, but they were weaker in Britain, Italy and Spain.

The two French companies have followed the same repayment rhythm, returning a first tranche of 1 billion euros ($1.5 billion) in the second half of 2010, then another 1 billion euros in February with the final 1 billion euros due on Tuesday.