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Viral disease and assisted reproduction technology
Published in David K. Gardner, Ariel Weissman, Colin M. Howles, Zeev Shoham, Textbook of Assisted Reproductive Techniques, 2017
Carole Gilling-Smith, Pietro Vernazza
A large randomized controlled trial (HPTN 052) investigated the impact of immediate HAART start (instead of delayed start according to treatment guidelines) on the risk of HIV transmission in HIV-discordant couples (14). This study found no case of transmission from any HIVinfected individual where blood viral load was suppressed. Further evidence supporting the Swiss statement came from the European Partner Study. In this observational study, HIV-serodiscordant couples who informed their physicians they were practicing sex without condoms were followed up with six-monthly HIV tests in the uninfected partner (15). After a total follow-up of 1238 couple-years, not a single case of transmission from the infected partner under HAART was documented. a density gradient to separate live spermatozoa from seminal plasma and non-germinal cells and, in most cases, this is followed by a swim-up. The technique rests on the fact that HIV is present in seminal fluid and as cell-associated virus in leukocytes and non-spermatozoa cells, but is not capable of attaching to or infecting spermatozoa (17–22). Whilst the technique remains a valid first-line treatment for men unable to achieve undetectable viral levels through HAART, for the vast majority of serodiscordant men with undetectable viral loads through HAART, sperm washing has become obsolete, and natural conception is increasingly considered the first-line option for conceiving a child without increasing the risk of HIV transmission to their partner or future child (23–25). However, not all couples or reproductive specialists understand this or are aware of the evidence cited above. On that basis, some couples still elect to continue to use condoms because of fear of sexual transmission of HIV to their partner, and seek out centers that can offer sperm washing. In practice, when couples are openly and correctly informed about the current evidence on sexual transmission risk, there is growing evidence that the majority will choose to conceive naturally (7).
HIV TB coinfection - perspectives from India
Published in Expert Review of Respiratory Medicine, 2021
Bharat Bhushan Rewari, Amitabh Kumar, Partha Pratim Mandal, Anoop Kumar Puri
The current standard of care for the treatment of HIV-1 infection is ‘triple-drug therapy’ with two nucleoside reverse transcriptase inhibitors (NRTI) or nucleotide reverse transcriptase inhibitors (NtRTI) backbones in combination with a non-nucleoside reverse transcriptase inhibitor (NNRTI). In the initial phase of ART scale up in 2004, the WHO and Indian guidelines were to start ART in patients with CD4 less than 200 or those with clinical stage 3 or 4. Over the years evidence from randomized control trials like CIPHRA HT 001, SMART, HPTN 052, and the recent START and TEMPRANO trials have led to guidelines for ART initiation being revised from CD4+ count less than 200 cells/µl in 2002, to 350 in 2010, 500 in 2013 to the current recommendation (2016) of initiating ART in all patients irrespective of CD4 count.
Contagiousness in treated HIV-1 infection
Published in Infectious Diseases, 2021
Jaran Eriksen, Jan Albert, Maria Axelsson, Torsten Berglund, Johanna Brännström, Hans Gaines, Magnus Gisslén, Peter Gröön, Per Hagstam, Lars Navér, Karin Pettersson, Jenny Stenkvist, Anders Sönnerborg, Anders Tegnell
Knowledge about how antiretroviral treatment (ART) reduces the contagiousness of people living with HIV (PLHIV) has gradually increased. Already in 2008, the Swiss National AIDS Commission stated that PLHIV on effective ART under certain conditions should not be considered contagious in sexual contacts [1]. In 2011, the HPTN 052 study showed that early antiretroviral therapy (in this document, ART means treatment for HIV-1) significantly reduced the risk of infection through sexual contacts [2]. Against this background the Public Health Agency of Sweden together with the Swedish Reference Group for Antiviral Therapy (RAV), in 2013, published a position statement on risk of HIV transmission from patients on antiretroviral therapy [3]. Since then, several key studies have been conducted, justifying a revision of the position statement and its conclusions.
Beyond one pill, once daily: current challenges of antiretroviral therapy management in the United States
Published in Expert Review of Clinical Pharmacology, 2019
Mary Clare Masters, Karen M. Krueger, Janna L. Williams, Lindsay Morrison, Susan E. Cohn
Treatment of PWH also serves an important public health role by reducing the risk of sexual, perinatal, and parenteral transmission of HIV. The landmark Pediatric AIDS Clinical Trials Group (PACTG) study 076 established that treating mothers with HIV and their newborn infants with ART dramatically reduced perinatal transmission of HIV [14]. Several large trials have concluded that effective ART prevents sexual transmission of HIV. In the HPTN 052 randomized controlled trial among HIV serostatus-discordant, mostly heterosexual couples, the partners with HIV were randomized to early versus the delayed start of ART [15]. The trial demonstrated a 93% reduction of HIV transmission among couples in the early ART group. There were eight transmissions in the early start group, and all occurred when the partner with HIV had a positive viral load (prior to suppression or during virologic failure). No transmissions were detected when viral loads were completely suppressed. The PARTNER study evaluated gay serostatus-discordant male couples over an average of 2 years with greater than 76,000 condomless sexual encounters reported. During this study, there were no phylogenetically linked within-couple transmissions [16].