Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy

University of North Carolina at Chapel Hill, Institute for Global Health and Infectious Diseases, Suite 2115, Bioinformatics Bldg., 130 Mason Farm Rd., CB 7030, Chapel Hill, NC 27599, USA.
New England Journal of Medicine (Impact Factor: 55.87). 08/2011; 365(6):493-505. DOI: 10.1056/NEJMoa1105243
Source: PubMed


Antiretroviral therapy that reduces viral replication could limit the transmission of human immunodeficiency virus type 1 (HIV-1) in serodiscordant couples.
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.
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 early-therapy 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).
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 number, NCT00074581.).

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    • "After the onset of acquired immune deficiency syndrome (AIDS), approximately 10-15% of the AIDS patients will develop HIV-associated dementia complex, characterized by cognitive, behavioral, and motor dysfunction [4]. The early initiation of antiretroviral therapy reduced rates of sexual transmission of HIV and clinical events such as early occurrence of pulmonary tuberculosis, severe bacterial infection or death [5]. However, with the advent of highly active antiretroviral therapy (HAART), rates of syphilis and other sexually transmitted diseases (STDs) have risen among men who have sex with men (MSM), reflecting a general increase in unsafe sexual behavior [6] [7]. "
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    ABSTRACT: Co-infection of human immunodeficiency virus (HIV) and neurosyphilis (NS) has become a rising trend, but the extent of brain damage associated with the concomitant infections remains unknown. Proton magnetic resonance spectroscopy ((1)H-MRS) can evaluate metabolic changes underlying early brain infections. 25 syphilitic patients (7 HIV-positive with NS; 6 HIV-positive without NS; 5 HIV-negative with NS; 7 non-HIV, non-NS) and 17 healthy controls (HC) underwent single-voxel (1)H-MRS in the bilateral hippocampi. Absolute concentrations of major metabolites were measured using a 3T MRI scanner. No significant structural abnormality was detected in all patients. However, metabolic changes were found in the left hippocampus of both the HIV-positive and NS subgroups, showing significantly higher choline (Cho), creatine (Cr) and myo-inositol (mI) compared to HC. In the right hippocampus, HIV-positive subgroup showed significantly higher Cr and reduced NAA, while NS subgroup only showed significantly reduced NAA compared to HC. The non-HIV, non-NS syphilitic subgroup showed no significant difference compared to HC. Substantial metabolic changes occurred in bilateral hippocampi in HIV and NS co-infections. NAA reduction might represent early neuronal damage, while mI/Cho elevation reflects gliosis/inflammatory changes. (1)H-MRS could serve as a non-invasive tool to triage patients suspected of NS for lumbar puncture in non-HIV syphilitic patients.
    American Journal of Nuclear Medicine and Molecular Imaging 01/2015; 5(1):83-94. · 3.25 Impact Factor
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    • "49 [77] [8] 53 [49] [5] 9 [30] [0] 8 [33] [3] 4 [50] [0] 13 [68] [4] B18.1 Chronische Virushepatitis B ohne Delta-Virus 5 [11] [4] -* 5 [4] [7] 7 [23] [3] 12 [50] [0] 1 [12] [5] 11 [57] [9] B18.2 Chronische Virushepatitis C 1 [2] [3] 1 [1] [6] 2 [1] [9] 2 [6] [7] 2 [8] [3] 4 [50] [0] 1 [5] [3] B17.1 Akute Virushepatitis C 7 [15] [9] 1 [1] [6] 8 [7] [5] 1 [3] [3] 0[0] [0] 0 [0] [0] 0 [0] [0] Z20.6 Kontakt mit und Exposition gegenüber HIV [Humanes Immundefizienz-Virus] Please cite this article in press as: Tomeczkowski J, et al. "
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    ABSTRACT: Anhand von Krankenkassendaten sollen die Anzahl der Personen in Deutschland unter Behandlung mit antiretroviralen Medikamenten (ARM) mit und ohne HIV-Diagnose ermittelt und Aussagen über die Verordnungsdauer in Abhängigkeit von Alter, Geschlecht und Therapieregime gemacht werden. Es wurden verschiedene Datenbanken mit mehreren Millionen Versicherten ausgewertet und auf die Population der gesetzlich Versicherten in Deutschland adjustiert hochgerechnet. Die Anzahl an Patienten mit ARM variierte zwischen den gesetzlichen Krankenkassen erheblich. Für ausschließlich zur Behandlung der HIV-Infektion zugelassene ARM nahm diese hochgerechnet innerhalb einer Datenbank in den Jahren von 2008 bis 2010 von 23.262 auf 30.200 zu. Für HIV und HIV/chronische Hepatitis B-zugelassene ARM betrug sie im Jahr 2011 in einer weiteren Datenbank 34.032. Bei 24,2% der mit HIV oder HIV/chronische Hepatitis B-zugelassenen ARM lag keine als gesichert dokumentierte HIV-Diagnose vor. Diese Personen waren signifikant häufiger weiblich und sie waren jünger im Vergleich zu Personen mit ARM und HIV-Diagnose. Der Einsatz von ARM ohne kodierte HIV-Diagnose erfolgte in 16,5% der Fälle zulassungskonform bei chronischer Hepatitis B und in ca. 7,7% der Fälle außerhalb der Zulassung. In durchschnittlich ca. 65,0% dieser Fälle war eine Hepatitis, in durchschnittlich ca. 10,0% eine HIV-Postexpositionsprophylaxe kodiert und in ca. 25,0% gab keine der kodierten Diagnosen einen Aufschluss auf die Verwendung der ARM. Bei Berücksichtigung dieser Diagnosen müsste die für das Jahr 2011 auf Basis von Verordnungsdaten, wo keine Diagnose vorliegt, ermittelte Anzahl therapieerfahrener Personen mit HIV-Infektion von 44.000 Patienten in der gesetzlicher Krankenversicherung (GKV) auf ca. 39.000 GKV-Versicherte mit dokumentierter HIV-Diagnose reduziert werden.
    Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen 11/2014; DOI:10.1016/j.zefq.2014.09.002
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    • "It is disturbing, however, that ART coverage for HIV-infected PWID remains low in Central Asia, despite data that demonstrate: (1) the power of combination prevention in reducing the incidence and prevalence of HIV (Degenhardt et al., 2010); (2) UNAIDS guidelines recommending that ART should be offered to PWID in combination with prevention and substance use treatment activities to maximise the potential of its success (UNAIDS, 2012); and (3) early ART treatment has been found to prevent sexual HIV transmission within serodiscordant couples in stable relationships (Cohen et al., 2011). "
    International Journal of Drug Policy 11/2014; 25(6):1155–1162. DOI:10.1016/j.drugpo.2014.09.015 · 2.40 Impact Factor
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