Science Breakthrough of the Year: Preventive Treatment of HIV with Early ART Therapy

Science magazine has chosen as its breakthrough of the year the use of Antiretroviral Therapy (ART) as an early preventive measure against infection with HIV-1, a strain of the Human Immunodeficiency Virus which can cause AIDS. The study, published originally in the NEJM, has produced some remarkable results.

It is not yet a cure for AIDS, but according to the results of the Paper Prevention of HIV-1 Infection with Early Antiretroviral Therapy, originally published in the New England Journal of Medicine, early treatment with Anti-Retroviral Therapy greatly diminishes infection rates with HIV-1.

The study, led by Dr. Myron S. Cohen of the University of North Carolina School of Medicine, USA, and the team referred below (*), involved 1,763 heterosexual serodiscordant couples (in which at the start of the trial, one of the partners was infected with HIV-1 and the other, not). All of those infected had relatively positive immune system readings, namely CD4 counts of 350 to 550 cells per cubic millimetre. ART therapy was given immediately to half of the group, while the other half had the treatment delayed until their immune systems registered high CD4 counts.

Early treatment with ART therapy produced a relative reduction of 96% in the number of transmissions of HIV-1 among the group receiving early ART therapy as compared with the control group receiving delayed ART therapy and an 89% reduction in HIV transmission in the total number of cases in the first group.

(*) Myron S. Cohen, M.D., Ying Q. Chen, Ph.D., Marybeth McCauley, M.P.H., Theresa Gamble, Ph.D., Mina C. Hosseinipour, M.D., Nagalingeswaran Kumarasamy, M.B., B.S., James G. Hakim, M.D., Johnstone Kumwenda, F.R.C.P., Beatriz Grinsztejn, M.D., Jose H.S. Pilotto, M.D., Sheela V. Godbole, M.D., Sanjay Mehendale, M.D., Suwat Chariyalertsak, M.D., Breno R. Santos, M.D., Kenneth H. Mayer, M.D., Irving F. Hoffman, P.A., Susan H. Eshleman, M.D., Estelle Piwowar-Manning, M.T., Lei Wang, Ph.D., Joseph Makhema, F.R.C.P., Lisa A. Mills, M.D., Guy de Bruyn, M.B., B.Ch., Ian Sanne, M.B., B.Ch., Joseph Eron, M.D., Joel Gallant, M.D., Diane Havlir, M.D., Susan Swindells, M.B., B.S., Heather Ribaudo, Ph.D., Vanessa Elharrar, M.D., David Burns, M.D., Taha E. Taha, M.B., B.S., Karin Nielsen-Saines, M.D., David Celentano, Sc.D., Max Essex, D.V.M., and Thomas R. Fleming, Ph.D. for the HPTN 052 Study Team

Universities and Institutions:

University of North Carolina School of Medicine, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (Y.Q.C., L.W.), and the University of Washington (T.R.F.) - both in Seattle; Family Health International, Arlington, VA (M.M.), and Durham, NC (T.G.); the UNC Project, Lilongwe (M.C.H.) and the College of Medicine-Johns Hopkins Project, Blantyre (J.K.) - both in Malawi; the Y.R. Gaitonade Center for AIDS Research and Education, Chennai (N.K.), and the National AIDS Research Institute, Pune (S.M., S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); Instituto de Pesquisa Clinica Evandro Chagas, Fiocruz (B.G.), and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.) - both in Rio de Janeiro; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil (B.R.S.); Fenway Health (K.H.M.) and Harvard School of Public Health (H.R., M.E.) - both in Boston; Johns Hopkins University School of Medicine (S.H.E., E.P.-M., J.G.) and Johns Hopkins Bloomberg School of Public Health (T.E.T., D.C.) - both in Baltimore; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention, Kenya Medical Research Institute-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu (L.A.M.); Perinatal HIV Research Unit (G.B.) and Department of Medicine (I.S.), University of the Witwatersrand, Johannesburg; University of California, San Francisco, San Francisco (D.H.); University of Nebraska Medical Center, Omaha (S.S.); Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (V.E., D.B.); and David Geffen UCLA School of Medicine, Los Angeles (K.N.-S.).

Timothy Bancroft-Hinchey

Pravda.Ru