Prevention of HIV Infection in Serodiscordant Couples with Early Antiretroviral Therapy

Winslow, Dean L.
September 2011
Infectious Disease Alert;Sep2011, Vol. 30 Issue 12, p137
A total of 1,763 HIV-1 serodiscordant couples in nine countries with the infected A partner having CD4+ counts of 350-500/mL were randomized 1:1 to early (immediate) vs. delayed (CD4+ had declined to ≤ 250/mL or after development of an AIDS-related illness) antiretroviral therapy of the infected partner. Fifty-four percent of the subjects were from Africa; 50% of the infected partners were men; 97% of couples were heterosexual; and 94% were married. As of February 2011, after a median follow-up of 1.7 years, a total of 39 HIV-1 transmissions were observed. Sequencing of the pol genes from linked cases showed that 28 were virologically linked to the infected partner. Of these linked transmissions, only 1 occurred in the early therapy group. Early antiretroviral therapy also resulted in fewer primary clinical endpoints (occurrence of pulmonary TB, severe bacterial infections, a WHO stage 4 event or death) in the HIV infected partners.


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