Bisher AKIL, MD

Transmission of HIV-1 Infection could be prevented with Early Antiretroviral Therapy

In HIV on July 20, 2011 at 12:49 am

A study published online by the New England Journal of Medicine , 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 at the time of enrollment in this study – median CD4 was 442 cells/ml3) or after a decline in the CD4 count or the onset of HIV-1–related symptoms (delayed therapy when CD4 counts were below 250 cells/ml3). 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). Authors conclusion: 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 article (10.1056/NEJMoa1105243) was published on July 18, 2011, at NEJM.org.]. Comment: this, with previously published studies, are strong evidence for early treatment, decreased transmission between discordant couple and controlled HIV replication _ I believe this is much more useful data that pre-exposure prophylaxis data, where we treat the healthy! BA

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