Prevention of HIV-1 infection with early antiretroviral therapy

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%...

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Main Authors: Cohen M., Chen Y., McCauley M., Gamble T., Hosseinipour M., Kumarasamy N., Hakim J., Kumwenda J., Grinsztejn B., Pilotto J., Godbole S., Mehendale S., Chariyalertsak S., Santos B., Mayer K., Hoffman I., Eshleman S., Piwowar-Manning E., Wang L., Makhema J., Mills L., De Bruyn G., Sanne I., Eron J., Gallant J., Havlir D., Swindells S., Ribaudo H., Elharrar V., Burns D., Taha T., Nielsen-Saines K., Celentano D., Essex M., Fleming T.
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Published: 2017
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http://cmuir.cmu.ac.th/jspui/handle/6653943832/43008
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Institution: Chiang Mai University
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spelling th-cmuir.6653943832-430082017-09-28T06:45:43Z Prevention of HIV-1 infection with early antiretroviral therapy Cohen M. Chen Y. McCauley M. Gamble T. Hosseinipour M. Kumarasamy N. Hakim J. Kumwenda J. Grinsztejn B. Pilotto J. Godbole S. Mehendale S. Chariyalertsak S. Santos B. Mayer K. Hoffman I. Eshleman S. Piwowar-Manning E. Wang L. Makhema J. Mills L. De Bruyn G. Sanne I. Eron J. Gallant J. Havlir D. Swindells S. Ribaudo H. Elharrar V. Burns D. Taha T. Nielsen-Saines K. Celentano D. Essex M. Fleming T. 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 earlytherapy 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.) Copyright © 2011 Massachusetts Medical Society. 2017-09-28T06:45:43Z 2017-09-28T06:45:43Z 2011-08-11 Journal 00284793 2-s2.0-80051633217 10.1056/NEJMoa1105243 https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=80051633217&origin=inward http://cmuir.cmu.ac.th/jspui/handle/6653943832/43008
institution Chiang Mai University
building Chiang Mai University Library
country Thailand
collection CMU Intellectual Repository
description 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 earlytherapy 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.) Copyright © 2011 Massachusetts Medical Society.
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author Cohen M.
Chen Y.
McCauley M.
Gamble T.
Hosseinipour M.
Kumarasamy N.
Hakim J.
Kumwenda J.
Grinsztejn B.
Pilotto J.
Godbole S.
Mehendale S.
Chariyalertsak S.
Santos B.
Mayer K.
Hoffman I.
Eshleman S.
Piwowar-Manning E.
Wang L.
Makhema J.
Mills L.
De Bruyn G.
Sanne I.
Eron J.
Gallant J.
Havlir D.
Swindells S.
Ribaudo H.
Elharrar V.
Burns D.
Taha T.
Nielsen-Saines K.
Celentano D.
Essex M.
Fleming T.
spellingShingle Cohen M.
Chen Y.
McCauley M.
Gamble T.
Hosseinipour M.
Kumarasamy N.
Hakim J.
Kumwenda J.
Grinsztejn B.
Pilotto J.
Godbole S.
Mehendale S.
Chariyalertsak S.
Santos B.
Mayer K.
Hoffman I.
Eshleman S.
Piwowar-Manning E.
Wang L.
Makhema J.
Mills L.
De Bruyn G.
Sanne I.
Eron J.
Gallant J.
Havlir D.
Swindells S.
Ribaudo H.
Elharrar V.
Burns D.
Taha T.
Nielsen-Saines K.
Celentano D.
Essex M.
Fleming T.
Prevention of HIV-1 infection with early antiretroviral therapy
author_facet Cohen M.
Chen Y.
McCauley M.
Gamble T.
Hosseinipour M.
Kumarasamy N.
Hakim J.
Kumwenda J.
Grinsztejn B.
Pilotto J.
Godbole S.
Mehendale S.
Chariyalertsak S.
Santos B.
Mayer K.
Hoffman I.
Eshleman S.
Piwowar-Manning E.
Wang L.
Makhema J.
Mills L.
De Bruyn G.
Sanne I.
Eron J.
Gallant J.
Havlir D.
Swindells S.
Ribaudo H.
Elharrar V.
Burns D.
Taha T.
Nielsen-Saines K.
Celentano D.
Essex M.
Fleming T.
author_sort Cohen M.
title Prevention of HIV-1 infection with early antiretroviral therapy
title_short Prevention of HIV-1 infection with early antiretroviral therapy
title_full Prevention of HIV-1 infection with early antiretroviral therapy
title_fullStr Prevention of HIV-1 infection with early antiretroviral therapy
title_full_unstemmed Prevention of HIV-1 infection with early antiretroviral therapy
title_sort prevention of hiv-1 infection with early antiretroviral therapy
publishDate 2017
url https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=80051633217&origin=inward
http://cmuir.cmu.ac.th/jspui/handle/6653943832/43008
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