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      Antiretroviral Therapy for the Prevention of HIV-1 Transmission

      Author(s): , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,
      Publication date Created:
      Publication date (Print):
      Journal: New England Journal of Medicine
      Publisher: Massachusetts Medical Society

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          Abstract

          An interim analysis of data from the HIV Prevention Trials Network (HPTN) 052 trial showed that antiretroviral therapy (ART) prevented more than 96% of genetically linked infections caused by human immunodeficiency virus type 1 (HIV-1) in serodiscordant couples. ART was then offered to all patients with HIV-1 infection (index participants). The study included more than 5 years of follow-up to assess the durability of such therapy for the prevention of HIV-1 transmission.

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          Prevention of HIV-1 infection with early antiretroviral therapy.

          Myron S Cohen, Ying Q Chen, Marybeth McCauley … (2012)
          Antiretroviral therapy that reduces viral replication could limit the transmission of human immunodeficiency virus type 1 (HIV-1) in serodiscordant couples. In nine countries, we enrolled 1763 couples in which one partner was HIV-1-positive and the other was HIV-1-negative; 54% of the subjects were from Africa, and 50% of infected partners were men. HIV-1-infected subjects with CD4 counts between 350 and 550 cells per cubic millimeter were randomly assigned in a 1:1 ratio to receive antiretroviral therapy either immediately (early therapy) or after a decline in the CD4 count or the onset of HIV-1-related symptoms (delayed therapy). The primary prevention end point was linked HIV-1 transmission in HIV-1-negative partners. The primary clinical end point was the earliest occurrence of pulmonary tuberculosis, severe bacterial infection, a World Health Organization stage 4 event, or death. As of February 21, 2011, a total of 39 HIV-1 transmissions were observed (incidence rate, 1.2 per 100 person-years; 95% confidence interval [CI], 0.9 to 1.7); of these, 28 were virologically linked to the infected partner (incidence rate, 0.9 per 100 person-years, 95% CI, 0.6 to 1.3). Of the 28 linked transmissions, only 1 occurred in the early-therapy group (hazard ratio, 0.04; 95% CI, 0.01 to 0.27; P<0.001). Subjects receiving early therapy had fewer treatment end points (hazard ratio, 0.59; 95% CI, 0.40 to 0.88; P=0.01). The early initiation of antiretroviral therapy reduced rates of sexual transmission of HIV-1 and clinical events, indicating both personal and public health benefits from such therapy. (Funded by the National Institute of Allergy and Infectious Diseases and others; HPTN 052 ClinicalTrials.gov number, NCT00074581.).
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            Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection

            Jens D Lundgren, Abdel Babiker, Fred Gordin … (2015)
            New England Journal of Medicine, 373(9), 795-807
            Article 0 comments Cited 511 times – based on 0 reviews     Review now
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              Sexual Activity Without Condoms and Risk of HIV Transmission in Serodifferent Couples When the HIV-Positive Partner Is Using Suppressive Antiretroviral Therapy

              Alison J. Rodger, Valentina Cambiano, Tina Bruun … (2016)
              A key factor in assessing the effectiveness and cost-effectiveness of antiretroviral therapy (ART) as a prevention strategy is the absolute risk of HIV transmission through condomless sex with suppressed HIV-1 RNA viral load for both anal and vaginal sex.
              Article 0 comments Cited 290 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Title: New England Journal of Medicine
                Abbreviated Title: N Engl J Med
                Publisher: Massachusetts Medical Society
                ISSN (Print): 0028-4793
                ISSN (Electronic): 1533-4406
                Publication date Created: September 2016
                Publication date (Print): September 2016
                Volume: 375
                Issue: 9
                Pages: 830-839
                Article
                DOI: 10.1056/NEJMoa1600693
                PMC ID: 5049503
                PubMed ID: 27424812
                SO-VID: bafdfd80-dc72-40d1-9f43-636ce3067408
                Copyright © © 2016
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