Editorials

HIV transmission in serodiscordant heterosexual couples

BMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.c2449 (Published 26 May 2010) Cite this as: BMJ 2010;340:c2449
  1. Marie-Claude Boily, senior lecturer in infectious disease ecology 1,
  2. Anne Buvé, professor2,
  3. Rebecca F Baggaley, research fellow 1
  1. 1Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London W2 1PG
  2. 2Department of Microbiology, Institute of Tropical Medicine, Antwerp, B-2000, Belgium
  1. mc.boily{at}imperial.ac.uk

    Risk is not zero but is low if the infected partner takes antiretrovirals

    Antiretroviral treatment inhibits HIV viral replication and reduces plasma viral load. Low plasma viral load is associated with a lower probability of HIV transmission, which opens the possibility of treatment to reduce HIV transmission.1 2 The feasibility, potential effectiveness, and risks of such treatment are unclear, and a key uncertainty is the extent to which successful antiretroviral treatment reduces HIV infectivity. In the linked observational study (doi:10.1136/bmj.c2205), Del Romero and colleagues estimate the risk of heterosexual transmission of HIV-1 from infected people taking combined antiretroviral treatment.3

    Only randomised controlled trials comparing transmission in HIV serodiscordant couples, where the infected (index) partner receives or does not receive antiretroviral drugs, can accurately estimate the effect of such treatment on infectivity. The HPTN-052 trial is the only ongoing trial of this type. In this trial, partners infected with HIV are assigned to immediate antiretroviral treatment or deferred treatment when their CD4 count drops below 250 cells/μl. This trial will hopefully provide a good estimate of the effect of antiretroviral treatment in patients with more than 250 CD4 cells/μl, but it will obviously not obtain an estimate in patients with fewer than 250 CD4 cells/μl.

    Evidence that …

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