Starting antiretrovirals early helps prevent HIV spread
Starting antiretroviral treatment early helps prevent the sexual transmission of HIV and delays the onset of HIV-related clinical events, new international research has shown.
The authors say their findings support the use of antiretroviral treatment as part of a public health strategy to reduce the spread of HIV. Their trial included over 1,700 treatment naive, HIV-1 infected adults who were in a stable relationship with an uninfected partner. Infected individuals were randomly allocated either to start antiretroviral treatment straight away (n=886) or delay treatment until they began to have HIV-related symptoms or their CD4 cell counts fell to 250 cells/mm3 or below (n=877).
The antiretroviral drugs used in the study, which were donated by the manufacturers, included various combinations of atazanavir, didanosine, efavirenz, emtricitabine, lamivudine, lopinavir, nevirapine, ritonavir, stavudine, tenofovir and zidovudine.
Transmission of HIV to the previously uninfected partner was 89 per cent less common among those who started therapy immediately compared with those in the delayed therapy group (hazard ratio 0.11, 95 per cent confidence interval 0.04–0.32; P<0.001).
Early therapy was also associated with a reduction in the incidence of serious HIV-related clinical events or death compared with delayed therapy (hazard ratio 0.59, CI 0.4–0.88; P=0.01).
There was no difference in the incidence of severe or life-threatening adverse events in the two groups (both 14 per cent; P=0.64). However, laboratory abnormalities such as neutropenia, abnormal phosphate levels and elevated bilirubin levels were more common in the early treatment group than in the delayed treatment group (27 per cent versus 18 per cent; P<0.001), although the authors say the clinical importance of this finding is unclear.
“The idea of HIV-1 treatment as prevention has garnered tremendous interest and hope,” they say.
They added: “In this trial, we found that early antiretroviral therapy had a clinical benefit for both HIV-1-infected persons and their uninfected sexual partners.”
The authors advise further examination of their data and additional follow-up in order to “better understand the clinical and public health benefits of early antiretroviral therapy, as compared with drug costs and side effects”.
The study was published online in the NEJM this week (18 July 2011) to coincide with presentation of the data at the International AIDS Society conference on HIV pathogenesis, treatment and prevention, which took place in Italy from 17–20 July 2011.
Citation: The Pharmaceutical Journal URI: 11081049
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