Antiretroviral Therapy for the Prevention of HIV-1 Transmission
Myron S. Cohen,Ying Q. Chen,Marybeth McCauley,Theresa Gamble,Mina C. Hosseinipour,Nagalingeswaran Kumarasamy,James Hakim,Johnstone Kumwenda,Beatriz Grinsztejn,José Henrique Pilotto,Sheela Godbole,Suwat Chariyalertsak,Breno Santos,Kenneth H. Mayer,Irving F. Hoffman,Susan H. Eshleman,Estelle Piwowar-Manning,Leslie Cottle,Xinyi C. Zhang,Joseph Makhema,Lisa A. Mills,Ravindre Panchia,Sharlaa Faesen,Joseph J. Eron,Joel E. Gallant,Diane V. Havlir,Susan Swindells,Vanessa Elharrar,David N. Burns,Taha E. Taha,Karin Nielsen-Saines,David D. Celentano,Max Essex,Sarah E. Hudelson,Andrew D. Redd,Thomas R. Fleming +35 more
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TLDR
The early initiation of ART led to a sustained decrease in genetically linked HIV-1 infections in sexual partners, and was associated with a 93% lower risk of linked partner infection than was delayed ART.Abstract:
BackgroundAn 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. MethodsWe randomly assigned 1763 index participants to receive either early or delayed ART. In the early-ART group, 886 participants started therapy at enrollment (CD4+ count, 350 to 550 cells per cubic millimeter). In the delayed-ART group, 877 participants started therapy after two consecutive CD4+ counts fell below 250 cells per cubic millimeter or if an illness indicative of the acquired immunodeficiency syndrome (i.e., an AIDS-defining illness) developed. The primary study end point was the diagnosis of genetically linked H...read more
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References
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Journal ArticleDOI
Prevention of HIV-1 Infection with Early Antiretroviral Therapy
Myron S. Cohen,Ying Q. Chen,Marybeth McCauley,Theresa Gamble,Mina C. Hosseinipour,Nagalingeswaran Kumarasamy,James Hakim,Johnstone Kumwenda,Beatriz Grinsztejn,José Henrique Pilotto,Sheela Godbole,Sanjay Mehendale,Suwat Chariyalertsak,Breno 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 J. Eron,Joel E. Gallant,Diane V. Havlir,Susan Swindells,Heather J. Ribaudo,Vanessa Elharrar,David N. Burns,Taha E. Taha,Karin Nielsen-Saines,David D. Celentano,Myron Essex,Thomas R. Fleming +34 more
TL;DR: In this article, Antiretroviral therapy that reduces viral replication could limit the transmission of human immunodeficiency virus type 1 (HIV-1) in serodiscordant couples.
Journal ArticleDOI
Prevention of HIV-1 infection with early antiretroviral therapy
TL;DR: The exciting evidence generated by this paper – that antiretroviral treatment of HIV-1 infection definitively reduces the risk of onward transmission of the virus by 96% – was rightly dubbed Science magazine's ‘Breakthrough of the Year’ in 2011.
Journal ArticleDOI
Viral Load and Heterosexual Transmission of Human Immunodeficiency Virus Type 1
Thomas C. Quinn,Maria J. Wawer,Nelson K. Sewankambo,David Serwadda,Chuanjun Li,Fred Wabwire-Mangen,Mary Meehan,Tom Lutalo,Ronald H. Gray +8 more
TL;DR: The viral load is the chief predictor of the risk of heterosexual transmission of HIV-1, and transmission is rare among persons with levels of less than 1500 copies of HIV -1 RNA per milliliter.
Journal ArticleDOI
Initiation of antiretroviral therapy in early asymptomatic HIV infection
Sean Emery,Shweta Sharma,Gerd Fätkenheuer,Josep M. Llibre,Jean-Michel Moli,Paula Munderi,Robin Wood,Karin L. Klingman,Simon Collins,H. Clifford Lane,Andrew N. Phil,James D. Neaton +11 more
TL;DR: The initiation of antiretroviral therapy in HIV-positive adults with a CD4+ count of more than 500 cells per cubic millimeter provided net benefits over starting such therapy in patients after the CD4+, but the risks of unscheduled hospital admissions were similar in the two groups.
Journal ArticleDOI
Sexual Activity Without Condoms and Risk of HIV Transmission in Serodifferent Couples When the HIV-Positive Partner Is Using Suppressive Antiretroviral Therapy
Alison Rodger,Valentina Cambiano,Tina Bruun,Pietro Vernazza,Simon Collins,Jan van Lunzen,Giulio Maria Corbelli,Vicente Estrada,Anna Maria Geretti,Apostolos Beloukas,David Asboe,Pompeyo Viciana,Félix Gutiérrez,Bonaventura Clotet,Christian Pradier,Jan Gerstoft,Rainer Weber,Katarina Westling,Gilles Wandeler,Jan M. Prins,Armin Rieger,Marcel Stoeckle,Tim Kümmerle,Teresa Bini,Adriana Ammassari,Richard Gilson,Ivanka Krznaric,Matti Ristola,Robert Zangerle,Pia Handberg,Antonio Antela,Sris Allan,Andrew N. Phillips,Jens D Lundgren +33 more
TL;DR: Evaluating the rate of within-couple HIV transmission among serodifferent heterosexual and MSM couples during periods of sex without condoms and when the HIV-positive partner had HIV-1 RNA load less than 200 copies/mL found no phylogenetically linked transmissions.
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