IAS: Early Antiretroviral Therapy Reduces HIV Transmission

Early initiation of therapy reduces transmission to HIV-1 negative partner, clinical end points

TUESDAY, July 19 (HealthDay News) -- Early antiretroviral therapy reduces sexual transmission in patients infected with HIV type 1 (HIV-1), according to a study published online July 18 in the New England Journal of Medicine to coincide with its presentation at the International AIDS Society Conference on Pathogenesis, Treatment, and Prevention, held from July 17 to 20 in Rome.

Myron S. Cohen, M.D., from the University of North Carolina School of Medicine in Chapel Hill, and colleagues investigated the effect of early antiretroviral therapy on HIV-1 transmission in 1,763 couples, in which one partner was infected and the other non-infected. Participants with HIV-1 who had CD-4 counts between 350 and 550 cells per cubic millimeter were randomized to receive antiretroviral therapy immediately (early therapy), or following a decrease in CD-4 count or at the onset of symptoms (delayed therapy). Linked HIV-1 transmission in previously non-infected partners was the primary prevention end point. Earliest occurrence of pulmonary tuberculosis, severe bacterial infection, a World Health Organization stage-4 event, or death were the primary clinical end points.

The investigators found that 39 HIV-1 transmissions had occurred by February 2011, with an incident rate (IR) of 1.2 per 100 person-years. Of these, 28 were linked to the infected partner (IR, 0.9 per 100 person-years) and only one was observed in the early-therapy group (hazard ratio [HR], 0.004). The early-therapy group had significantly fewer treatment end points (HR, 0.59).

"The early initiation of antiretroviral therapy reduced rates of sexual transmission of HIV-1 and clinical events," the authors write.

Several authors (study and editorial) disclosed financial ties to the pharmaceutical industry, which provided the study drugs.

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