Author | Cohen, Myron S. | |
Author | Chen, Ying Q. | |
Author | McCauley, Marybeth | |
Author | Gamble, Theresa | |
Author | Hosseinipour, Mina C. | |
Author | Kumarasamy, Nagalingeswaran | |
Author | Hakim, James G. | |
Author | Kumwenda, Johnstone | |
Author | Grinsztejn, Beatriz | |
Author | Pilotto, Jose H. S. | |
Author | Godbole, Sheela V. | |
Author | Mehendale, Sanjay | |
Author | Chariyalertsak, Suwat | |
Author | Santos, Breno R. | |
Author | Mayer, Kenneth H. | |
Author | Hoffman, Irving F. | |
Author | Eshleman, Susan H. | |
Author | Piwowar-Manning, Estelle | |
Author | Wang, Lei | |
Author | Makhema, Joseph | |
Author | Mills, Lisa A. | |
Author | de Bruyn, Guy | |
Author | Sanne, Ian | |
Author | Eron, Joseph | |
Author | Gallant, Joel | |
Author | Havlir, Diane | |
Author | Swindells, Susan | |
Author | Ribaudo, Heather | |
Author | Elharrar, Vanessa | |
Author | Burns, David | |
Author | Taha, Taha E. | |
Author | Nielsen-Saines, Karin | |
Author | Celentano, David | |
Author | Essex, Max | |
Author | Fleming, Thomas R. | |
Access date | 2016-09-20T16:16:16Z | |
Available date | 2016-09-20T16:16:16Z | |
Document date | 2011 | |
Citation | COHEN, Myron S. et al. Prevention of HIV-1 Infection with Early Antiretroviral Therapy. N Engl J Med., v.365, p.493-505, 2011. | pt_BR |
ISSN | 0028-4793 | pt_BR |
URI | https://www.arca.fiocruz.br/handle/icict/15870 | |
Language | eng | pt_BR |
Publisher | Massachusetts Medical Society | pt_BR |
Rights | restricted access | pt_BR |
Subject in Portuguese | Infecção por HIV-1 | pt_BR |
Subject in Portuguese | Terapia anti-retroviral | pt_BR |
Subject in Portuguese | Prevenção | pt_BR |
Title | Prevention of HIV-1 Infection with Early Antiretroviral Therapy | pt_BR |
Type | Article | pt_BR |
Abstract | 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.) | pt_BR |
Affilliation | University of North Carolina. School of Medicine. South Carolina, USA. | pt_BR |
Affilliation | Fred Hutchinson Cancer Research Center. Seattle, Washington, USA. | pt_BR |
Affilliation | Family Health International. Arlington, VA, USA. | pt_BR |
Affilliation | Family Health International. Durham, NC, USA. | pt_BR |
Affilliation | University of North Carolina. School of Medicine. South Carolina, USA. | pt_BR |
Affilliation | Gaitonade Center for AIDS Research and Education. Chennai, India. | pt_BR |
Affilliation | University of Zimbabwe, Harare, Zimbabwe. | pt_BR |
Affilliation | College of Medicine.Johns Hopkins Project, Blantyre, India. | pt_BR |
Affilliation | Fundação Oswaldo Cruz. Instituto de Pesquisa Clinica Evandro Chagas. Rio de Janeiro, RJ, Brasil. | pt_BR |
Affilliation | Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de AIDS e Imunologia Molecular. Rio de Janeiro, RJ, Brasil / Hospital Geral de Nova Iguaçu. Nova Iguaçu, RJ. Brasil. | pt_BR |
Affilliation | National AIDS Research Institute. Pune, India. | pt_BR |
Affilliation | National AIDS Research Institute. Pune, India. | pt_BR |
Affilliation | Chiang Mai University. Research Institute for Health Sciences.Chiang Mai, Thailand. | pt_BR |
Affilliation | Hospital Nossa Senhora da Conceição. Porto Alegre, RS, Brasil. | pt_BR |
Affilliation | Fenway Health. Boston, USA. | pt_BR |
Affilliation | University of North Carolina. School of Medicine. South Carolina, USA. | pt_BR |
Affilliation | Johns Hopkins University School of Medicine. Baltimore. USA. | pt_BR |
Affilliation | Johns Hopkins University School of Medicine. Baltimore. USA. | pt_BR |
Affilliation | Fred Hutchinson Cancer Research Center. Seattle, USA. | pt_BR |
Affilliation | Botswana Harvard AIDS Institute. Gaborone. Botswana. | pt_BR |
Affilliation | Kenya Medical Research Institute. CDC Research and Public Health Collaboration HIV Research Branch. Kisumu, Kenia. | pt_BR |
Affilliation | Perinatal HIV Research Unit. Johannesburg, South Africa. | pt_BR |
Affilliation | University of the Witwatersrand. Department of Medicine. Johannesburg, South Africa. | pt_BR |
Affilliation | University of North Carolina School of Medicine. Chapel Hill, Seattle, USA. | pt_BR |
Affilliation | Johns Hopkins University School of Medicine. Baltimore, USA. | pt_BR |
Affilliation | University of California. San Francisco, CA, USA. | pt_BR |
Affilliation | University of Nebraska Medical Center. Omaha, Nebraska, USA. | pt_BR |
Affilliation | Harvard School of Public Health. Boston, USA. | pt_BR |
Affilliation | National Institutes of Health. National Institute of Allergy and Infectious Diseases. Bethesda, MD, USA. | pt_BR |
Affilliation | National Institutes of Health. National Institute of Allergy and Infectious Diseases. Bethesda, MD, USA. | pt_BR |
Affilliation | Johns Hopkins Bloomberg School of Public Health.Baltimore, USA. | pt_BR |
Affilliation | David Geffen UCLA School of Medicine. Los Angeles, CA, USA. | pt_BR |
Affilliation | Johns Hopkins Bloomberg School of Public Health.Baltimore, USA. | pt_BR |
Affilliation | Harvard School of Public Health. Boston, USA. | pt_BR |
Affilliation | University of Washington. Washington, USA. | pt_BR |
Subject | HIV-1 Infection | pt_BR |
Subject | Antiretroviral Therapy | pt_BR |
Subject | Prevention | pt_BR |
e-ISSN | 1533-4406 | |
Embargo date | 2030-01-01 | |