Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (Covid-19), has generated a worldwide pandemic. The interruption of its spread depends on ...a combination of pharmacologic and nonpharmacologic interventions. Initial SARS-CoV-2 prevention includes social distancing, the use of face masks, environmental hygiene, and hand washing.
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Although the most important pharmacologic interventions to prevent SARS-CoV-2 infection are likely to be vaccines, the repurposing of established drugs for short-term prophylaxis is another, more immediate option. Some researchers have promoted chloroquine and hydroxychloroquine for the treatment and prevention of illness from a variety of microorganisms, including SARS-CoV.
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Hydroxychloroquine . . .
By the end of 2020, more than 19 million Americans had received the diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
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Although a substantial proportion of these ...infections remained asymptomatic, complications of coronavirus disease 2019 (Covid-19) had led to more than 330,000 deaths in the United States.
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During the past year, a remarkable effort has been devoted to the development of vaccines to prevent Covid-19 and to reduce morbidity and mortality among those who are infected. Equally important is the development of treatments that can prevent the progression of Covid-19 from the inception of infection. In this issue . . .
This Viewpoint discusses the potential role of neutralizing monoclonal antibodies (MAbs) as a treatment for coronavirus disease 2019 (COVID-19) and as a means of prevention in high-risk populations, ...and it also raises possible limitations of the approach that need to be disproven or addressed for the strategy to be effective.
Combination prevention for COVID-19 Cohen, Myron S; Corey, Lawrence
Science (American Association for the Advancement of Science),
05/2020, Letnik:
368, Številka:
6491
Journal Article
Recenzirano
Odprti dostop
The coronavirus disease 2019 (COVID-19) pandemic has produced the fear and disorder inevitably provoked by emerging pathogens. As such, it should also inspire consideration of our experience with HIV ...over the past 40 years. As with HIV, the road to reducing infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the cause of COVID-19), and attendant morbidity and mortality, requires medical and nonmedical strategies. The most important lesson learned from tackling HIV is to use a combination of prevention strategies.
In this article, the authors discuss the challenges of SARS-CoV-2 infection in patients with a weakened immune system, including the potential implications regarding viral evolution and transmission.
In December, 2011, Science recognised the findings of the HPTN 052 study1 as the scientific breakthrough of the year.2 This study showed a 96% reduction in sexual transmission of HIV in serodifferent ...couples (one partner HIV positive, the other HIV negative) when the HIV-positive partner was successfully treated with antiretroviral therapy (ART).1 However, the HPTN 052 study included only a small number of men who have sex with men (MSM), for whom HIV acquisition often includes anal exposure, an efficient route of HIV transmission.3 Furthermore, the couples in the HPTN 052 study were counselled to use condoms, so the observed benefits of ART also reflected the contribution of safer sexual behaviours. ...other investigators4,5 have subsequently studied HIV transmission in couples who specifically chose not to use condoms. Incident sexually transmitted infections have frequently been detected in either partner in studies of serodifferent couples, indicating additional sexual contacts.1,4,5,7 In gay couples in the PARTNER studies, a total of 15 HIV infections acquired outside the primary partnership were observed.5 Ajit Solanki/Associated Press Use of pre-exposure prophylaxis (PrEP) with the combination of emtricitabine and tenofovir disoproxil fumarate by the HIV-negative partner was an exclusion criterion for eligible couple-years of follow-up in the PARTNER studies,4,5 but this intervention has emerged as an important method for HIV prevention11 and is one of the pillars of the US HIV elimination plan.10 PrEP offers protection from HIV acquisition.10,11 Indeed, a recent survey reported PrEP to be more popular and trusted by MSM for HIV prevention than treatment as prevention,12 reflecting the complex considerations of the HIV-negative partner in a sexual relationship.
Antiretroviral drugs that inhibit viral replication were expected to reduce transmission of HIV by lowering the concentration of HIV in the genital tract. In 11 of 13 observational studies, ...antiretroviral therapy (ART) provided to an HIV-infected index case led to greatly reduced transmission of HIV to a sexual partner. In the HPTN 052 randomised controlled trial, ART used in combination with condoms and counselling reduced HIV transmission by 96·4%. Evidence is growing that wider, earlier initiation of ART could reduce population-level incidence of HIV. However, the full benefits of this strategy will probably need universal access to very early ART and excellent adherence to treatment. Challenges to this approach are substantial. First, not all HIV-infected individuals can be located, especially people with acute and early infection who are most contagious. Second, the ability of ART to prevent HIV transmission in men who have sex with men (MSM) and people who use intravenous drugs has not been shown. Indeed, the stable or increased incidence of HIV in MSM in some communities where widespread use of ART has been established emphasises the concern that not enough is known about treatment as prevention for this crucial population. Third, although US guidelines call for immediate use of ART, such guidelines have not been embraced worldwide. Some experts do not believe that immediate or early ART is justified by present evidence, or that health-care infrastructure for this approach is sufficient. These concerns are very difficult to resolve. Ongoing community-based prospective trials of early ART are likely to help to establish the population-level benefit of ART, and—if successful—to galvanise treatment as prevention.
The HIV Prevention Trials Network 052 study (HPTN 052) was a clinical trial designed to determine whether early treatment for HIV infection prevented transmission of the virus in couples where one ...partner was infected with HIV and the other was not, referred to as HIV serodiscordant or serodifferent couples. The study enrolled 1,763 couples at 13 sites in 9 countries in Asia, Africa, and the Americas. HPTN 052 demonstrated a minimum of 96% reduction of HIV in heterosexual couples ascribed to antiretroviral treatment; early treatment of HIV significantly reduced other infections in the HIV-infected subjects. This study, in conjunction with similar research, led to significant changes in international HIV treatment guidelines and the concept of treatment as prevention (TasP). This article provides the scientific background and history of how HPTN 052 came into being, the challenges it faced, and the ultimate impact it had on the fields of HIV treatment and prevention.
Antiretroviral therapy (ART) has the potential to prevent human immunodeficiency virus (HIV) transmission by reducing the concentration of HIV in blood and genital secretions. Indeed, mathematical ...models with favorable assumptions suggest the potential of ART to stop the spread of HIV infection. Empirical results from ecological and population-based studies and from several short-term observational studies involving HIV status-discordant heterosexual couples suggest that ART reduces the rate of HIV transmission. A multinational, randomized, controlled trial (National Institutes of Health HPTN052) examining the reliability and durability of ART as prevention of transmission in HIV status-discordant couples is under way. The latter and other studies also consider sexual risk-taking behavior and transmission of HIV-resistant variants when ART is used as prevention. Early HIV detection and treatment (ie, test and treat) are being considered as an important prevention strategy. In this article, we review the data supporting the use of ART to prevent HIV transmission and critically examine the public health implications of this strategy.
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