Antiretroviral therapy and the prevention of sexually transmitted HIV infection

BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d7796 (Published 02 December 2011) Cite this as: BMJ 2011;343:d7796
  1. George W Rutherford, professor
  1. 1Cochrane HIV/AIDS Group, Department of Epidemiology and Biostatistics and Global Health Sciences, University of California, San Francisco, CA 94105, USA
  1. grutherford{at}psg.ucsf.edu

Early treatment in infected partners reduces transmission and improves clinical outcomes

Antiretroviral drugs have been used to prevent the transmission of HIV since the 1990s. The demonstration that zidovudine decreased the risk of HIV infection after percutaneous exposure,1 and success in prevention of mother to child transmission,2 have led to antiretrovirals being used for HIV prevention. However, transmission of HIV mostly occurs during sexual intercourse, and successes in this area have lagged behind. Prophylaxis after sexual exposure, although an established clinical practice,3 has not been evaluated in a randomised controlled trial. More recently, large well conducted trials demonstrated the effectiveness of pre-exposure prophylaxis of uninfected people, using tenofovir and emtricitabine or 1% tenofovir vaginal gel.4 5

Cohort studies suggested as early as 1994 that treating HIV infected patients with antiretroviral therapy (ART) would decrease the likelihood of them infecting their sexual partners. Seven cohort studies have examined this question in discordant couples, in which one sexual partner is infected with HIV and the other is not. A systematic review found that these studies had a pooled relative effect of 0.34 (95% confidence …

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