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ART and HIV: Treatment as Prevention. Myron S. Cohen, MD University of North Carolina. Treatment as Prevention Discordant Couples?. POSITIVE RESULTS IN OBSERVATIONAL STUDIES Bunnell (JAIDS, 2007) Sullivan (IAS 2008) Donnell (Lancet, 2010) Romero (BMJ, 2010) NEGATIVE RESULTS

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art and hiv treatment as prevention
ART and HIV:Treatment as Prevention

Myron S. Cohen, MD

University of North Carolina

treatment as prevention discordant couples
Treatment as PreventionDiscordant Couples?

POSITIVE RESULTS IN OBSERVATIONAL STUDIES

Bunnell (JAIDS, 2007)

Sullivan (IAS 2008)

Donnell (Lancet, 2010)

Romero (BMJ, 2010)

NEGATIVE RESULTS

Wang (IAS, 2010, JAIDS, in press)

hiv treatment as prevention sullivan et al croi ias 2009
HIV Treatment as PreventionSullivan et al. CROI, IAS 2009

2,993 couples studied 2002-2008

512 days follow-up (mean)

175 transmission events,

with 4/175 from subjects receiving ART

80% reduced risk of HIV transmission

BUT…the risk of HIV with ART was NOT zero

chinese couples study wang lu et al ias 2010 jaids in press wang thpdc102 ias 2010
Chinese Couples StudyWang Lu et al. IAS 2010, JAIDS in press Wang ThPDC102, IAS 2010

1,927 discordant couples in Henan followed 2006-2008

1,396 index cases receiving FREE ART

84 seroconversions distributed equally among subjects on and off ART

Will ART offer “REAL WORLD” benefit???

test and treat conclusions 2010
Test and TreatConclusions 2010
  • ART has the power to reduce onward transmission of HIV, but the magnitude and durability is unknown
  • The population benefit of ART will depend on
    • durable transmission suppression
    • PREVENTING transmitted resistance
    • dealing with acute HIV infection