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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?. 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

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  1. ART and HIV:Treatment as Prevention Myron S. Cohen, MD University of North Carolina

  2. 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)

  3. 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

  4. 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???

  5. 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

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