Cheers for a Public Health Home Run

I am a baseball fan, so I love to jump to my feet and cheer a home run.

I just now opened up the August 11 issue of the New England Journal of Medicine.  There is a clear public health homerun in the lead article (Prevention of HIV-1 infection with early antiretroviral therapy.  Cohen MS et al.  NEJM 2011; 365:493-505).  

This paper describes a randomized controlled trial done in 9 countries.  Partners who were discordant for HIV infection (i.e., one partner was infected and one not) were randomized to receive antiretroviral treatment right away, or to wait until the CD4 counts began to drop, which is the current clinical standard.  The results were dramatic.  There were 28 instances of transmission to a partner in the course of the study, but only one of the 28 occurred in the early treatment group.  You don’t need a biostatistician to tell you that 1 versus 27 is way over the fence.  For Rockies fans, can you hear the organist playing now?

So as I now settle back into my chair and reach for my bag of peanuts, I am reminded the game is not over.  We are only in the fifth inning of the AIDS game.  Momentum is on our side, but we have lots of examples of past hits, even some extra base hits, that sometimes did not score enough.  Applying the many new prevention methods we are discovering requires continued improvement of health care and public health systems and continual reinforcement of the public will.  But this sort of clear impact on HIV transmission should give us all renewed enthusiasm in the public health fight against AIDS.