| Content Provider |
World Health Organization (WHO)-Global Index Medicus |
| Author |
Gamble, Theresa Eshleman, Susan H. Piwowar-manning, Estelle Eron, Joseph Taha, Taha E. Mayer, Kenneth H. Hakim, James G. Godbole, Sheela V. Kumarasamy, Nagalingeswaran Kumwenda, Johnstone Celentano, David Cohen, Myron S. Burns, David Makhema, Joseph Ribaudo, Heather Hosseinipour, Mina C. Mills, Lisa A. Fleming, Thomas R. Chariyalertsak, Suwat Mehendale, Sanjay Havlir, Diane Swindells, Susan Santos, Breno R. Sanne, Ian Chen, Ying Q. Elharrar, Vanessa Nielsen-saines, Karin Mccauley, Marybeth Pilotto, Jose H. S. De Bruyn, Guy Gallant, Joel Grinsztejn, Beatriz Wang, Lei Hoffman, Irving F. Essex, Max |
| Description |
Author Affiliation: Cohen MS ( University of North Carolina at Chapel Hill, Institute for Global Health and Infectious Diseases, Suite 2115, Bioinformatics Bldg., 130 Mason Farm Rd., CB 7030, Chapel Hill, NC 27599, USA. mscohen@med.unc.edu) |
| 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 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). 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 ClinicalTrials.gov number, NCT00074581.). |
| ISSN |
00284793 |
| e-ISSN |
15334406 |
| Journal |
New England Journal of Medicine |
| Issue Number |
6 |
| Volume Number |
365 |
| Language |
English |
| Publisher |
Massachusetts Medical Society (United States) |
| Publisher Date |
2011-08-11 |
| Publisher Place |
United States |
| Access Restriction |
Open |
| Subject Keyword |
Anti-Retroviral Agents Therapeutic Use Disease Transmission, Infectious Prevention & Control HIV Infections HIV-1 Adolescent Adverse Effects Disease Progression Drug Therapy, Combination Drug Therapy Transmission HIV Seropositivity Kaplan-Meier Estimate Proportional Hazards Models Sexual Partners Spouses Multicenter Study Randomized Controlled Trial Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Medicine |
| Content Type |
Text |
| Resource Type |
Article |
| Subject |
Medicine |
