Prevention of HIV-1 infection with early antiretroviral therapy

January 01, 0001

Prevention of HIV-1 infection with early antiretroviral therapy

Antiretroviral therapy that reduces viral replication could limit the transmission of human immunodeficiency virus type 1 (HIV-1) in serodiscordant couples. In nine countries, the authors from multiple countries 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.

They found: "As of February 21, 2011, a total of 39 HIV-1 transmissions were observed (incidence rate, 1.2 per 100 person-years); of these, 28 were virologically linked to the infected partner (incidence rate, 0.9 per 100 person-years). Of the 28 linked transmissions, only 1 occurred in the early-therapy group (hazard ratio, 0.04). Subjects receiving early therapy had fewer treatment end points (hazard ratio, 0.59)."

The authors concluded: "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.

This should become standard practice.

For the full abstract, click here.

N Engl J Med 365:493-505, 11 August 2011 © 2011 to the Massachusetts Medical Society
Prevention of HIV-1 Infection with Early Antiretroviral Therapy. Myron S. Cohen, Ying Q. Chen, Marybeth McCauley, et al. Correspondence to Dr. Cohen: [email protected]

Category: B. Blood, Immune Mechanisms. Keywords: HIV, sexual transmission, prevention, antiretroviral therapy, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 23 August 2011

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