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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Prevention of HIV-1 infection with early antiretroviral therapy
New England Journal of Medicine, Volume 365, No. 6, Year 2011
Notification
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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.
Authors & Co-Authors
Cohen, Myron S.
United States, Chapel Hill
Unc School of Medicine
Chen, Yingqing
United States, Seattle
Fred Hutchinson Cancer Research Center
McCauley, Marybeth B.
United States, Durham
Fhi 360
Gamble, Theresa R.
United States, Durham
Fhi 360
Hosseinipour, Mina C.
United States, Chapel Hill
Unc School of Medicine
Malawi, Lilongwe
Unc Project-malawi
Kumarasamy, Nagalingeswaran
India, Chennai
Y r Gaitonade Center for Aids Research and Education
Hakim, James Gita
Zimbabwe, Harare
University of Zimbabwe
Kumwenda, Johnstone J.
Malawi, Zomba
University of Malawi
Grinsztejn, Beatriz Gilda Jegerhorn
Brazil, Rio de Janeiro
Instituto Nacional de Infectologia Evandro Chagas Ini
Pilotto, José Henrique S.
Brazil, Rio de Janeiro
Hospital Geral de Rio de Janeiro
Godbole, Sheela V.
India, Pune
National Aids Research Institute India
Mehendale, Sanjay Madhav
India, Pune
National Aids Research Institute India
Chariyalertsak, Suwat
Thailand, Chaing Mai
Chiang Mai University
Santos, Breno Riegel
Brazil, Tubarao
Hospital Nossa Senhora da Conceicao
Mayer, Kenneth H.
United States, Boston
Fenway Community Health Center
Hoffman, Irving F.
United States, Chapel Hill
Unc School of Medicine
Eshleman, Susan H.
United States, Baltimore
Johns Hopkins University
Piwowar-Manning, Estelle M.
United States, Baltimore
Johns Hopkins University
Wang, Lei
United States, Seattle
Fred Hutchinson Cancer Research Center
Makhema, Joseph M.
Botswana, Gaborone
Botswana Harvard Aids Institute Partnership
Mills, Lisa A.
Kenya, Nairobi
Kenya Medical Research Institute
De Bruyn, Guy
South Africa, Johannesburg
University of the Witwatersrand
Sanne, Ian
South Africa, Johannesburg
University of the Witwatersrand
Eron, Joseph J.
United States, Chapel Hill
Unc School of Medicine
Gallant, Joel E.
United States, Baltimore
Johns Hopkins University
Havlir, Diane V.
United States, San Francisco
University of California, San Francisco
Swindells, Susan N.
United States, Omaha
University of Nebraska Medical Center
Ribaudo, Heather J.
United States, Boston
Harvard T.h. Chan School of Public Health
Elharrar, Vanessa N.
United States, Bethesda
National Institute of Allergy and Infectious Diseases Niaid
Burns, David N.
United States, Bethesda
National Institute of Allergy and Infectious Diseases Niaid
Taha, Taha E.
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Nielsen-Saines, Karin A.
United States, Los Angeles
David Geffen School of Medicine at Ucla
Celentano, David D.
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Essex, Max E.
United States, Boston
Harvard T.h. Chan School of Public Health
Fleming, Thomas R.
United States, Seattle
University of Washington
Statistics
Citations: 35
Authors: 35
Affiliations: 24
Identifiers
Doi:
10.1056/NEJMoa1105243
ISSN:
00284793
e-ISSN:
15334406
Research Areas
Environmental
Infectious Diseases
Sexual And Reproductive Health
Study Design
Cohort Study
Participants Gender
Male