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Title: Prevention of HIV-1 infection with early antiretroviral therapy
Authors: Myron S. Cohen
Ying Q. Chen
Marybeth McCauley
Theresa Gamble
Mina C. Hosseinipour
Nagalingeswaran Kumarasamy
James G. Hakim
Johnstone Kumwenda
Beatriz Grinsztejn
Jose H.S. Pilotto
Sheela V. Godbole
Sanjay Mehendale
Suwat Chariyalertsak
Breno R. Santos
Kenneth H. Mayer
Irving F. Hoffman
Susan H. Eshleman
Estelle Piwowar-Manning
Lei Wang
Joseph Makhema
Lisa A. Mills
Guy De Bruyn
Ian Sanne
Joseph Eron
Joel Gallant
Diane Havlir
Susan Swindells
Heather Ribaudo
Vanessa Elharrar
David Burns
Taha E. Taha
Karin Nielsen-Saines
David Celentano
Max Essex
Thomas R. Fleming
Keywords: Medicine
Issue Date: 11-Aug-2011
Abstract: BACKGROUND: Antiretroviral therapy that reduces viral replication could limit the transmission of human immunodeficiency virus type 1 (HIV-1) in serodiscordant couples. METHODS: 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. RESULTS: 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 earlytherapy 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). CONCLUSIONS: 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 number, NCT00074581.) Copyright © 2011 Massachusetts Medical Society.
ISSN: 15334406
Appears in Collections:CMUL: Journal Articles

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