Please use this identifier to cite or link to this item: https://www.arca.fiocruz.br/handle/icict/16404
Title: Antiretroviral Therapy for the Prevention of HIV-1 Transmission
Authors: 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.
Chariyalertsak, Suwat
Santos, Breno R.
Mayer, Kenneth H.
Hoffman, Irving F.
Eshleman, Susan H.
Piwowar-Manning, Estelle
Cottle, Leslie
Zhang, Xinyi C.
Makhema, Joseph
Mills, Lisa A.
Panchia, Ravindre
Faesen, Sharlaa
Eron, Joseph
Gallant, Joel
Havlir, Diane
Swindells, Susan
Elharrar, Vanessa
Burns, David
Taha, Taha E.
Nielsen-Saines, Karin
Celentano, David D.
Essex, Max
Hudelson, Sarah E.
Redd, Andrew D.
Fleming, Thomas R.
Affilliation: University of North Carolina at Chapel Hill. Department of Medicine. Chapel Hill, North Carolina, USA.
Fred Hutchinson Cancer Research Center. Divisions of Vaccine and Infectious Disease. Public Health Science. Seattle, Washington, USA.
FHI 360. Washington, DC, USA.
FHI 360. Durham, North Carolina, USA.
University of North Carolina at Chapel Hill. Department of Medicine. Chapel Hill, North Carolina, USA.
Gaitonde Center for AIDS Research and Education. Chennai, India.
University of Zimbabwe. Harare, Zimbabwe.
College of Medicine–Johns Hopkins Project. Blantyre, Malawi.
Fundação Oswaldo Cruz. Instituto Pesquisa Clinica Evandro Chagas. Rio de Janeiro, RJ. Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de AIDS e Imunologia Molecular. Rio de Janeiro, RJ, Brasil / Hospital Geral de Nova Iguaçu, Rio de Janeiro, RJ, Brasil.
National AIDS Research Institute. Pune, India.
Chiang Mai University. Research Institute for Health Sciences. Chiang Mai, Thailand.
Hospital Nossa Senhora da Conceicao/GHC. Servico de Infectologia. Porto Alegre, RS, Brasil.
Fenway Institute. Boston, USA.
University of North Carolina at Chapel Hill. Department of Medicine. Chapel Hill, North Carolina, USA.
Johns Hopkins University School of Medicine. Departments of Pathology. Baltimore, USA.
Johns Hopkins University School of Medicine. Departments of Pathology. Baltimore, USA.
Fred Hutchinson Cancer Research Center. Statistical Center for HIV/AIDS Research and Prevention. Seattle, USA.
Fred Hutchinson Cancer Research Center. Divisions of Vaccine and Infectious Disease. Seattle, USA.
Botswana Harvard AIDS Institute. Gaborone, Botswana.
Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI– CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya.
University of the Witwatersrand. Perinatal HIV Research Unit. Johannesburg, South Africa.
University of the Witwatersrand. Department of Medicine. Faculty of Health Sciences. Johannesburg, South Africa.
University of North Carolina at Chapel Hill. Department of Medicine. Chapel Hill, North Carolina, USA.
Southwest CARE Center. Santa Fe. Mexico.
University of California. San Francisco, CA, USA.
University of Nebraska Medical Center, Omaha, Nebraska, USA.
Johns Hopkins Bloomberg School of Public Health. Division of AIDS. Maryland, USA.
Johns Hopkins Bloomberg School of Public Health. Division of AIDS. Maryland, USA.
Jonhs Hopkins University School of Medicine. Department of Epidemiology. Bloomberg School of Public Health. Baltimore, USA.
David Geffen UCLA School of Medicine. Division of Infectious Diseases. Los Angeles. CA, USA.
Johns Hopkins Bloomberg School of Public Health. Baltimore, USA.
Harvard School of Public Health. Boston, USA.
Jonhs Hopkins University School of Medicine. Department of Patology. Baltimore, USA.
National Institutes of Health. National Institute of Allergy and Infectious Diseases. Laboratory of Immunoregulation. Bethesda, Maryland, USA.
University of Washington. Fred Hutchinson Cancer Research Center. Department of Biostatistics. Seattle, USA.
Abstract: BACKGROUND An interim analysis of data from the HIV Prevention Trials Network (HPTN) 052 trial showed that antiretroviral therapy (ART) prevented more than 96% of genetically linked infections caused by human immunodeficiency virus type 1 (HIV-1) in serodiscordant couples. ART was then offered to all patients with HIV-1 infection (index participants). The study included more than 5 years of follow-up to assess the durability of such therapy for the prevention of HIV-1 transmission. METHODS We randomly assigned 1763 index participants to receive either early or delayed ART. In the early-ART group, 886 participants started therapy at enrollment (CD4+ count, 350 to 550 cells per cubic millimeter). In the delayed-ART group, 877 participants started therapy after two consecutive CD4+ counts fell below 250 cells per cubic millimeter or if an illness indicative of the acquired immunodeficiency syndrome (i.e., an AIDS-defining illness) developed. The primary study end point was the diagnosis of genetically linked HIV-1 infection in the previously HIV-1– negative partner in an intention-to-treat analysis. RESULTS Index participants were followed for 10,031 person-years; partners were followed for 8509 person-years. Among partners, 78 HIV-1 infections were observed during the trial (annual incidence, 0.9%; 95% confidence interval [CI], 0.7 to 1.1). Viral-linkage status was determined for 72 (92%) of the partner infections. Of these infections, 46 were linked (3 in the early-ART group and 43 in the delayed-ART group; incidence, 0.5%; 95% CI, 0.4 to 0.7) and 26 were unlinked (14 in the early-ART group and 12 in the delayed-ART group; incidence, 0.3%; 95% CI, 0.2 to 0.4). Early ART was associated with a 93% lower risk of linked partner infection than was delayed ART (hazard ratio, 0.07; 95% CI, 0.02 to 0.22). No linked infections were observed when HIV-1 infection was stably suppressed by ART in the index participant. CONCLUSIONS The early initiation of ART led to a sustained decrease in genetically linked HIV-1 infections in sexual partners. (Funded by the National Institute of Allergy and Infectious Diseases; HPTN 052 ClinicalTrials.gov number, NCT00074581.).
Keywords: Antiretroviral Therapy
Prevention
HIV-1 Transmission
keywords: HIV-1
Prevenção
Terapia Anti-retroviral
Issue Date: 2016
Publisher: Massachussets Medical Society
Citation: COHEN, M. S. et al. Antiretroviral Therapy for the Prevention of HIV-1 Transmission. New England Journal of Medicine, v. 375, n. 9, p. 830-839, 2016.
DOI: 10.1056/NEJMoa1600693
ISSN: 0028-4793
Copyright: restricted access
Appears in Collections:INI - Artigos de Periódicos
IOC - Artigos de Periódicos

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