Journal ArticleDOI
Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis
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Studies of heterosexual discordant couples observed no transmission in patients treated with ART and with viral load below 400 copies/ml, but data were compatible with one transmission per 79 person-years, which is needed to better define the risk of HIV transmission from patients on ART.Abstract:
OBJECTIVES: To synthesize the evidence on the risk of HIV transmission through unprotected sexual intercourse according to viral load and treatment with combination antiretroviral therapy (ART). DESIGN: Systematic review and meta-analysis. METHODS: We searched Medline, Embase and conference abstracts from 1996-2009. We included longitudinal studies of serodiscordant couples reporting on HIV transmission according to plasma viral load or use of ART and used random-effects Poisson regression models to obtain summary transmission rates [with 95% confidence intervals, (CI)]. If there were no transmission events we estimated an upper 97.5% confidence limit. RESULTS: We identified 11 cohorts reporting on 5021 heterosexual couples and 461 HIV-transmission events. The rate of transmission overall from ART-treated patients was 0.46 (95% CI 0.19-1.09) per 100 person-years, based on five events. The transmission rate from a seropositive partner with viral load below 400 copies/ml on ART, based on two studies, was zero with an upper 97.5% confidence limit of 1.27 per 100 person-years, and 0.16 (95% CI 0.02-1.13) per 100 person-years if not on ART, based on five studies and one event. There were insufficient data to calculate rates according to the presence or absence of sexually transmitted infections, condom use, or vaginal or anal intercourse. CONCLUSION: Studies of heterosexual discordant couples observed no transmission in patients treated with ART and with viral load below 400 copies/ml, but data were compatible with one transmission per 79 person-years. Further studies are needed to better define the risk of HIV transmission from patients on ART.read more
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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.
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Antiretroviral prophylaxis for HIV prevention in heterosexual men and women.
Jared M. Baeten,Deborah Donnell,Deborah Donnell,Patrick Ndase,Nelly Mugo,Nelly Mugo,James D. Campbell,Jonathan Wangisi,Jordan W. Tappero,Elizabeth A. Bukusi,Craig R. Cohen,Elly Katabira,Allan R. Ronald,Allan R. Ronald,Elioda Tumwesigye,Edwin Were,Kenneth H. Fife,James Kiarie,James Kiarie,Carey Farquhar,Grace John-Stewart,Aloysious Kakia,Josephine Odoyo,Akasiima Mucunguzi,Edith Nakku-Joloba,Rogers Twesigye,Kenneth Ngure,Cosmas Apaka,Harrison Tamooh,Fridah Gabona,Andrew Mujugira,Dana Panteleeff,Katherine K. Thomas,Lara Kidoguchi,Meighan Krows,Jennifer Revall,Susan Morrison,Harald S. Haugen,Mira Emmanuel-Ogier,Lisa Ondrejcek,Robert W. Coombs,Lisa M. Frenkel,Lisa M. Frenkel,Craig W. Hendrix,Namandjé N. Bumpus,David R. Bangsberg,Jessica E. Haberer,Wendy S. Stevens,Jairam R. Lingappa,Connie Celum +49 more
TL;DR: Oral TDF and TDF-FTC both protect against HIV-1 infection in heterosexual men and women, and both study medications significantly reduced the HIV- 1 incidence among both men andWomen.
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Antiretroviral Treatment of Adult HIV Infection: 2012 Recommendations of the International Antiviral Society–USA Panel
Huldrych F. Günthard,Judith A. Aberg,Joseph J. Eron,Jennifer F Hoy,Amalio Telenti,Constance A. Benson,David M. Burger,Pedro Cahn,Joel E. Gallant,Marshall J. Glesby,Peter Reiss,Michael S. Saag,David L. Thomas,Donna M. Jacobsen,Paul A. Volberding +14 more
TL;DR: This report provides guidelines for when to initiate antiretroviral therapy, selection of appropriate initial regimens, patient monitoring, when to change therapy, and what regimens to use when changing.
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The Spectrum of Engagement in HIV Care and its Relevance to Test-and-Treat Strategies for Prevention of HIV Infection
Edward M. Gardner,Margaret P. McLees,John F. Steiner,John F. Steiner,Carlos del Rio,William J. Burman +5 more
TL;DR: The spectrum of engagement in care for HIV-infected individuals in the United States is reviewed and this information is applied to help understand the magnitude of the challenges that pooragement in care will pose to test-and-treat strategies for HIV prevention.
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Code Saturation Versus Meaning Saturation: How Many Interviews Are Enough?
TL;DR: In this article, the authors compared two approaches to assess saturation: code saturation and meaning saturation, and examined sample sizes needed to reach saturation in each approach, what saturation meant, and how to assess it.
References
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Users' Guides to the Medical Literature
Gordon H. Guyatt,Drummond Rennie +1 more
TL;DR: Without a way of critically appraising the information they receive, clinicians are relatively helpless in deciding what new information to learn and decide how to modify their practice.
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
What is “quality of evidence” and why is it important to clinicians?
Gordon H. Guyatt,Andrew D Oxman,Regina Kunz,Gunn Elisabeth Vist,Yngve Falck-Ytter,Holger J. Schünemann +5 more
TL;DR: Guideline developers use a bewildering variety of systems to rate the quality of the evidence underlying their recommendations as mentioned in this paper, some are facile, some confused, and others sophisticated but complex.
Journal ArticleDOI
Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model
TL;DR: A theoretical strategy of universal voluntary HIV testing and immediate treatment with ART, combined with present prevention approaches, could have a major effect on severe generalised HIV/AIDS epidemics.
Journal ArticleDOI
Rates of HIV-1 Transmission per Coital Act, by Stage of HIV-1 Infection, in Rakai, Uganda
Maria J. Wawer,Ronald H. Gray,Nelson K. Sewankambo,David Serwadda,Xianbin Li,Oliver Laeyendecker,Noah Kiwanuka,Godfrey Kigozi,Mohammed Kiddugavu,Tom Lutalo,Fred Nalugoda,Fred Wabwire-Mangen,Mary P. Meehan,Thomas C. Quinn,Thomas C. Quinn +14 more
TL;DR: The rate of HIV transmission per coital act was highest during early-stage infection, which has implications for HIV prevention and for projecting the effects of antiretroviral treatment on HIV transmission.
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