What are the DHHS guidelines for antiretroviral therapy of HIV infection in serodiscordant couples?

Updated: Apr 18, 2019
  • Author: R Chris Rathbun, PharmD, BCPS (AQ-ID), AAHIVP; Chief Editor: John Bartlett, MD  more...
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Answer

Answer

A HIV serodiscordant couple is generally defined as two people in an ongoing sexual relationship where one person is living with HIV and the second person is not. In 2011, a Cochrane Database of Systematic Reviews analysis of 7 observational studies found that ART is very potent for the prevention of HIV in couples in which only one partner is infected with the virus. Results show that in serodiscordant couples, uninfected partners of infected individuals being treated with antiretroviral drugs have a 5-fold lower risk of contracting HIV compared to uninfected partners of infected individuals not receiving treatment. [144]

A multicontinent, randomized, controlled trial by the HIV Prevention Trials Network (HPTN 052) in 2011 evaluated early versus delayed antiretroviral therapy for HIV-infected patients with CD4 counts between 350 and 550/µL who were in stable sexual relationships with noninfected partners. Findings show that early initiation of antiretroviral therapy reduced transmission rates of the disease by 96%. Early therapy was also associated with a 41% reduction in the number of HIV-related clinical events. [145]

The PARTNER Study group looked at 888 serodiscordant couples (heterosexual and MSM) who reported condomless sex. Results reported no documented cases of within-couple HIV transmission if the HIV-positive partner was on suppressive ART. [146]  This finding was supported when  HPTN 052 follow-up data reported that among this cohort, partner linked infections (through phylogenetic and statistical methods) were not observed when virologic suppression was achieved with ART. [147]

Given these most recent data, the CDC released a Dear Colleague letter in September 2017 that stated “people who take ART daily as prescribed and achieve and maintain an undetectable viral load have effectively no risk of sexually transmitting the virus to an HIV-negative partner.” [148]


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