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CDC preparing fact sheet on ART, risk of transmission
Assessing the science as clinical trials continue
The Centers for Disease Control and Prevention is planning to issue a fact sheet on what is currently known about Antiretroviral Therapy (ART) and sexual transmission in the first quarter of this year, the agency announced. The CDC will also submit a scientific statement for publication in a peer-reviewed scientific journal. In the interim, CDC has reiterated its recommendation that people living with HIV who are sexually active use condoms consistently and correctly with all sex partners.
Observational studies to date have shown that ART is associated with a decreased risk of transmission to sex partners. A clinical trial to directly address this question is ongoing. The CDC sponsored a meeting in Atlanta on October 23-24, 2008, entitled, "CDC Expert Consultation on the Effect of ART on Risk of Sexual Transmission of HIV Infection and Superinfection." Approximately 50 HIV experts attended including laboratory scientists, clinicians, social and behavioral scientists, and public health personnel from CDC and other federal agencies, state and local health departments, universities, advocacy groups, and international organizations. Participants reviewed available data and discussed implications for treatment and prevention programs and for future research.
"The consultation highlighted the contribution of ART to prevention of HIV transmission, and the potential to increase the prevention benefit by expanding HIV testing, ensuring linkage to and availability of treatment services, and, possibly, making treatment available to infected individuals with CD4 counts >350/mm3," the CDC reported. "However, additional laboratory, clinical, epidemiologic, mathematical modeling, and behavioral research, along with health care financing and policy discussions, are needed to inform specific guidance on these issues."
The presentations and discussions indicated that there is evidence that the infectiousness of HIV-infected persons is related to their blood viral load, which is correlated with genital viral shedding. ART can be expected to reduce HIV concentrations in the blood and seminal plasma, female genital tract secretions, and rectal secretions. While some studies have shown successful long-term suppression of genital HIV shedding with ART, in other studies episodes of genital HIV shedding have been observed despite ongoing ART. There is also significant variation in the penetration of antiretroviral drugs from the blood into the genital tract.