Catálogo general VIH/sida
Prevention of HIV-1 infection with early antiretroviral therapy
Resumen
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.) (Resumen extraído del artículo)- Tema:
Autoría:
COHEN, Myron S.; CHEN, Ying Q.; MCCAULEY, Marybeth; GAMBLE, Theresa; HOSSEINIPOUR, Mina C.; KUMARASAMY, Nagalingeswaran; HAKIM, James G.; KUMWENDA, Johnstone; GRINSZTEJN, Beatriz; PILOTTO, Jose H.S.; GODBOLE, Sheela V.; MEHENDALE, Sanjay; CHARIYALERTSAK, Suwat; SANTOS, Breno R.; MAYER, Kenneth H.; HOFFMAN, Irving F.; ESHLEMAN, Susan H.; PIWOWAR-MANNING, Estelle; WANG, Lei; MAKHEMA, Joseph; MILLS, Lisa A.; BRUYN, Guy de; SANNE, Ian; ERON, Joseph; GALLANT, Joel; HAVLIR, Diane; SWINDELLS, Susan; RIBAUDO, Heather; ELHARRAR, Vanessa; BURNS, David; TAHA, Taha E.; NIELSEN-SAINES, Karin; CELENTANO, David D.; ESSEX, Max; FLEMING, Thomas R.
Autoría institucional: HPTN 052 Study Team
Autoría institucional: HPTN 052 Study Team
Ficha bibliográfica
- Año de publicación:
- 2011
- Publicación:
- Boston : Massachusetts Medical Society
- En :
- Número:
- Vol. 365, no. 6 (August 11, 2011), p. 493-505
- Formato:
- Artículo
- Más información:
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