A recent study published in the New England Journal of Medicine reported that in 2014 there were more than 2 million new HIV-1 infections worldwide, most of which occurred via sexual transmission. Effective HIV-1 prevention strategies are required to reduce the risk of viral transmission from infected persons to their sexual partners. Other studies involving serodiscordant couples have suggested that antiretroviral therapy (ART) in those with HIV-1 infection reduces the risk of sexual transmission.
The HIV Prevention Trials Network (HPTN) 052 trial, led by Myron S. Cohen, MD, was designed to determine the efficacy of antiretroviral therapy (ART) on preventing genetically-linked HIV-1 transmission in serodiscordant couples (n=1,763). In the trial, early-ART was initiated when the CD4+ count was 350 to 550/mm3. Delayed-ART was initiated when the CD4+ count was < 250/mm3 or when an AIDS-defining illness was diagnosed.
The authors reported that the incidence of HIV-1 infections in the seronegative partners was 0.9%/year during more than 5 years of follow-up. Early-ART was found to be more effective in preventing HIV-1 infections (93% reduction; HR = 0.7) than delayed-ART.
“After the release of the interim study results, 17% of the index participants in the delayed-ART group initially chose not to start ART, even though they were informed of the personal and public health benefits of such therapy,” study authors explained in their article. “This finding probably reflects the relative good health of the participants with HIV-1 infection and the former recommendations of worldwide guidelines that ART was not required for the treatment of infection until there was a decrease in the CD4+ count or a deterioration in health. We hope that the newly emphasized importance of early initiation of ART will encourage patients with HIV-1 infection to start such therapy without delay.”
Note: Funded by the National Institute of Allergy and Infectious Diseases; HPTN 052 ClinicalTrials.gov number, NCT00074581.