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Prevention of HIV-1 infection with early antiretroviral therapy.


ABSTRACT: 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.).

SUBMITTER: Cohen MS 

PROVIDER: S-EPMC3200068 | biostudies-literature | 2011 Aug

REPOSITORIES: biostudies-literature

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Prevention of HIV-1 infection with early antiretroviral therapy.

Cohen Myron S MS   Chen Ying Q YQ   McCauley Marybeth M   Gamble Theresa T   Hosseinipour Mina C MC   Kumarasamy Nagalingeswaran N   Hakim James G JG   Kumwenda Johnstone J   Grinsztejn Beatriz B   Pilotto Jose H S JH   Godbole Sheela V SV   Mehendale Sanjay S   Chariyalertsak Suwat S   Santos Breno R BR   Mayer Kenneth H KH   Hoffman Irving F IF   Eshleman Susan H SH   Piwowar-Manning Estelle E   Wang Lei L   Makhema Joseph J   Mills Lisa A LA   de Bruyn Guy G   Sanne Ian I   Eron Joseph J   Gallant Joel J   Havlir Diane D   Swindells Susan S   Ribaudo Heather H   Elharrar Vanessa V   Burns David D   Taha Taha E TE   Nielsen-Saines Karin K   Celentano David D   Essex Max M   Fleming Thomas R TR  

The New England journal of medicine 20110718 6


<h4>Background</h4>Antiretroviral therapy that reduces viral replication could limit the transmission of human immunodeficiency virus type 1 (HIV-1) in serodiscordant couples.<h4>Methods</h4>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  ...[more]

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