Skip directly to local search Skip directly to A to Z list Skip directly to navigation Skip directly to site content Skip directly to page options
CDC Home

Effect of Antiretroviral Therapy on Risk of Sexual Transmission of HIV Infection and Superinfection


  1. Quinn TC, Wawer MJ, Sewnkanbo N, et al. for the Rakai Project Study Group. Viral Load and heterosexual transmission of human immunodeficiency virus type-1. NEJM 2000;342:921-929
  2. Castilla J, del Romero J, Hernando V, Marincovich B, Garcia S, Rodriguez C. Effectiveness of highly active antiretroviral therapy in reducing heterosexual transmission of HIV. JAIDS 2005;40:96-101.
  3. Reynolds S, Makumbi F, Kayaagi J, et al. ART reduced the rate of sexual transmission of HIV HIV-discordant couples in rural Rakai , Uganda . Abstract 52a, 16th Conference on Retroviruses and Opportunistic Infections , Montreal , February 8-11, 2009.
  4. Sullivan P, Kayitenkore K, Chomba E, et al. Reduction of HIV transmission risk and high risk sex while prescribed ART: Results from discordant couples in Rwanda and Zambia . Abstract 52bLB, 16th Conference on Retroviruses and Opportunistic Infections , Montreal , February 8-11, 2009.
  5. Porco TC, Martin JN, Page-Shafer KA, et al. Decline in HIV infectivity following the introduction of highly active antiretroviral therapy. AIDS 2004;18:81-88.
  6. Blower SM, Gershengorn H, and Grant R. A tale of two futures: HV and antiretroviral therapy in San Francisco . Science 2000 Jan 28; 287: 650-654.
  7. Granich RM, Gilks CF, Dye C, DeCock KM. Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for eliminating HIV transmission: a mathematical model. Lancet 2009;373:48-57.
  8. Sturmer M, Doerr HW, Berger A, Gale P. Is transmission of HIV in non-viraemic serodiscordant couples possible? Antivir Ther 2008;13:729-732.
  9. Ibanez A, Puig T, Elias J, Clotet C, Ruiz L, Martinez M-A. Quantification of integrated and total HIV-1 DNA after long-term highly active antiretroviral therapy in HIV-1 infected patients. AIDS 1999;13:105-109.
  10. Furtado MR, Callaway DS, Phair JP, et al. Persistence of HIV-1 transcription in peripheral blood mononuclear cells in patients receiving potent antiretroviral therapy. N Engl I Med 1999;340:1614-1622.
  11. Vernazza PL, Troiani L, Flepp MJ, et al. Potent antiretroviral treatment of HIV infection results in suppression of the seminal shedding of HIV. AIDS 2000;14:117-121.
  12. Zhang H, Dornadula G, Beumont M, et al. Human immunodeficiency virus type 1 on the semen of men receiving highly active antiretroviral therapy. N Engl J Med 1998;339:1803-1809.
  13. Barroso PF, Harrison LH, de Fatima Melo M, et al, Adherence to antiretroviral therapy and persistence of HIV RNA in semen. JAIDS 2003;32:435-40.
  14. Cu-Uvin S, Caliendo AM, Reinert S, et al. Effect of highly active antiretroviral therapy on cervicovaginal HIV-1 RNA. AIDS 2000;14:415-421.
  15. Cu-Uvin S, Snyder B, Harwell JI, et al. Association between paired plasma and cervicovaginal lavage fluid HIV-1 levels during 36 months. J Acquir Immune Defic Syndr 2006;42:584-57.
  16. Fiore, JR, Suligoi B, Saracino A, et al. Correlates of HIV-1 shedding in cervicovaginal secretions and effects of antiretroviral therapies. AIDS 2003;17(15):2169-76.
  17. Neely MN, Benning L, Xu J et al. Cervical shedding of HIV-1 RNA among women with low levels of viremia while receiving highly active antiretroviral therapy. JAIDS 2007; 44(1):38-42.
  18. Di Mascio M, Markowitz M, Louie M, et al. Viral blip dynamics during highly active antiretroviral therapy. J Virol 2003;77:12165-12172.
  19. Nettles RWE, Kieffer TL, Kwon P et al. Intermittent HIV-1 Viremia (blips) and drug resistance in patients receiving HAART. JAMA 2005;293:817-829.
  20. van Sighem A, Zhang S, Reiss P, et al. Immunologic, virologic, and clinical consequences of episodes of transient viremia during suppressive combination antiretroviral therapy. J Acq Immune Defic Syndr 2008;48:104-108.
  21. Kalichman SC , Di Berto G, Eaton L. Human immunodeficiency virus viral load in blood plasma and semen: review and implications of empirical findings.
  22. Cohen M, Galvin S. The role of sexually transmitted diseases in HIV transmission. Nat Rev Microbiol 2004;2:39-41.
  23. Cohen MS, Hoffman IF, Royce RA, et al, for the AIDSCAP Malawi Research Group. Reduction of concentration of HIV-1 in semen after the treatment of urethritis: Implications for prevention of sexual transmission of HIV-1. Lancet 1997;349;1868-73.
  24. Kashuba AD, Dyer JR, Kramer LM, et al. Antiretroviral drug concentrations in semen: implications for sexual transmission of HIV-1. Antimicrob Agents Chemother 1999;43:1817-26.
  25. Vergara TR, Estrela RC, Suarez-Kurtz G, et al. Limited Penetration of Lopinavir and Ritonavir in the Genital Tract of Men Infected with HIV-1 in Brazil . Ther Drug Monit 2006;28:175–179.
  26. Dumond JB, Yeh RF, Patterson KB, et al. Antiretroviral drug exposure in the female genital tract: implications for oral pre- and post-exposure prophylaxis. AIDS 2007;21(14):1899-907.
  27. Min SS, Corbett AH, Rezk N, et al. Protease inhibitor and nonnucleoside reverse transcriptase inhibitor concentrations n the genital tract of HIV-1 infected women. JAIDS 2004;37:1577-1580.
  28. Bryn RA, Kiessling AA. Analysis of human immunodeficiency virus in semen: indications of a genetically distinct virus reservoir. J Reprod Immunol 1998;41:161-176.
  29. Kiessling AA, Fitzgerald LM, Zhang D, et al. Human Immunodeficiency virus in semen arises from a genetically distinct virus reservoir. AIDS Res Hum Retroviruses 1998;14(Suppl. 1):S33-41.
  30. Eyre RC, Zheng G, Kiessling AA. Multiple drug resistance mutations in human immunodeficiency virus in semen but not in blood of a man on antiretroviral therapy. Urology 2000;55xvii-xx.
  31. Wilson DP, Law MG, Grulich AE, Cooper DA, Kaldor JM. Relation between HIV viral load and infectiousness: a model-based analysis. Lancet 2008;372:314-320.
  32. Attia S, Egger M, Müller M, Zwahlen M, Low N. Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis. AIDS 2009; electronic publication ahead of print, April 17, 2009.
  33. Blower S, Volberding, P. What can modeling tell us about the threat of antiviral drug resistance. Current Opinion in Infectious Diseases 2002;15:609-614.
  34. Culshaw, R. Mathematical modeling of AIDS progression: limitations, expectations, and future directions. Journal of American Physicians and Surgeons 2006;11:101-105.
  35. Crepaz N, Hart TA, Marks G. Highly active antiretroviral therapy and risk behavior: a meta-analytic view. JAMA 2004;292:224-236.
  36. Hollingsworth TD, Anderson RM, Fraser C. HIV-1 transmission by stage of infection. J Infect Dis 2008;198:687-93.
  37. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. November 3, 2008. Accessed June 24, 2009 (Page 20).
  38. Strategies for Management of Antiretroviral Therapy (SMART) Study Group, Emery S, Neuhaus JA, Phillips AN, et al. Major clinical outcomes in antiretroviral therapy (ART)-naïve participants and in those not receiving ART at baseline in the SMART study. J Infect Dis 2008; 197:1084-1086.
  39. When to Start Consortium. Timing of initiation of antiretroviral therapy in AIDS-free HIV-1-infected patients: a collaborative analysis of 19 HIV cohort studies. Lancet 2009; 373:1352-63.
  40. Kitahata MM, Gange SJ, Abraham AG, et al for the NA-ACCORD Investigators. Effect of early versus deferred therapy for HIV on survival. N Engl J Med 2009 (E-publication ahead of print, 1 April 2009).
  41. Robbins GK, Spritzler JG, Chan ES, et al for the AIDS Clinical Trials Group 384 Team. Incomplete reconstitution of T cell subsets on combination antiretroviral therapy in the AIDS Clinical Trials Group protocol 384. Clin Infect Dis 2009;48:350-61.
  42. Lichtenstein KA, Armon C, Buchacz K, et al for the HIV Outpatient Study (HOPS) Investigators. Initiation of antiretroviral therapy at CD4 cell counts >/=350 cells/mm3 does not increase incidence or risk of peripheral neuropathy, anemia, or renal insufficiency. J Aquir Immune Defic Synd 2008;47:27-35.
  43. HIV Prevention Trials Network. HPTN052 Study Information. (accessed 5 April 2009).
  44. Smith DM, Richman DD, Little SJ. HIV superinfection. J Infect Dis 2005;192:438-444.
  45. Smith DM, Wong JK, Daar ES, Richman DD, Little SJ. Incidence of HIV superinfection following primary infection. JAMA 2004;292:1177-78.
  46. Piantadosi A, Chohan B, Chohan V, McClellan RS, Overbaugh J. Chronic HIV infection frequently fails to protect against superinfection. PLoS Pathogens . 2007 Nov;3:1745-1760
  47. Streeck H, Li B, Poon AF, et al. Immune-driven recombination and loss of control after superinfection . J Exp Med 2008;205:1789-96.
  48. Los Alamos National Laboratories HIV Sequence Databases. The circulating recombinant forms. Accessed June 22, 2009.
  49. Chakraborty B, Valer L, De Mendoza C, Soriano V, Quinones-Mateu RE. Failure to detect human immunodeficiency virus type 1 superinfection in 28 HIV-seroconcordant individuals with high risk of reexposure to the virus. AIDS Res Hum Retroviruses 2004;20:1026-31.
  50. Gonzales MJ, Delwart E, Rhee SY, et al. Lack of detectable human immunodeficiency virus type 1 superinfection during 1072 person-years of observation. J Infect Dis . 2003 Aug 1;188:397-405.
  51. Centers for Disease Control and Prevention. Incorporating HIV prevention into the medical care of persons living with HIV: recommendations of CDC, the Health Resources and Services Administration, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR 2003;52(No. RR-12): 1-24.
  52. Centers for Disease Control and Prevention. CDC underscores current recommendation for preventing HIV transmission. February 1, 2008. Accessed June 22, 2009.

Top of Page


Get Tested

Find an HIV testing site near you.

Search location, such as: "Atlanta, GA", or "30033".

For more information, please visit

Please contact with any comments, suggestions, or concerns.

Syndicate This Content Podcast button Tell us what you think button CDC-INFO The U.S. Government's Official Web PortalDepartment of Health and Human Services
Centers for Disease Control and Prevention   1600 Clifton Road Atlanta, GA 30329-4027, USA
800-CDC-INFO (800-232-4636) TTY: (888) 232-6348 - Contact CDC–INFO