Abstract
BackgroundAlthough HIV treatment as prevention (TasP) via early antiretroviral therapy (ART) has proven to reduce transmissions among HIV-serodiscordant couples, its full implementation in developing countries remains a challenge. In this study, we determine whether China's current HIV treatment program prevents new HIV infections among discordant couples in rural China.MethodsA prospective, longitudinal cohort study was conducted from June 2009 to March 2011, in rural Yunnan. A total of 1,618 HIV-discordant couples were eligible, 1,101 were enrolled, and 813 were followed for an average of 1.4 person-years (PY). Routine ART was prescribed to HIV-positive spouses according to eligibility (CD4<350 cells/µl). Seroconversion was used to determine HIV incidence.ResultsA total of 17 seroconversions were documented within 1,127 PY of follow-up, for an overall incidence of 1.5 per 100 PY. Epidemiological and genetic evidence confirmed that all 17 seroconverters were infected via marital secondary sexual transmission. Having an ART-experienced HIV-positive partner was associated with a lower rate of seroconvertion compared with having an ART-naïve HIV-positive partner (0.8 per 100 PY vs. 2.4 per 100 PY, HR = 0.34, 95%CI = 0.12–0.97, p = 0.0436). While we found that ART successfully suppressed plasma viral load to <400 copies/ml in the majority of cases (85.0% vs. 19.5%, p<0.0001 at baseline), we did document five seroconversions among ART-experienced subgroup.ConclusionsART is associated with a 66% reduction in HIV incidence among discordant couples in our sample, demonstrating the effectiveness of China's HIV treatment program at preventing new infections, and providing support for earlier ART initiation and TasP implementation in this region.
Highlights
At the end of 2011, approximately 780,000 people were living with HIV/AIDS and heterosexual transmission remained the primary mode of transmission in 47% of cases in China [1]
Effective viral suppression through antiretroviral therapy (ART) has been associated with a significant reduction in infectivity and diminished risk of HIV transmission in studies conducted in North America [8,9], Africa [5,10,11], Europe [12], and South America[13]
The benefit of ART in preventing new HIV infections has been confirmed by the HIV Prevention Trials Network (HPTN) 052 study, a two-arm, multi-site randomized trial on the effectiveness of treatment strategies among serodiscordant couples, which found that early initiation of ART results in a 96% reduction in sexual transmission [14]
Summary
At the end of 2011, approximately 780,000 people were living with HIV/AIDS and heterosexual transmission remained the primary mode of transmission in 47% of cases in China [1]. Antiretroviral therapy (ART) is increasingly recognized as a very promising strategy for reducing HIV transmission among discordant couples [6,7]. The benefit of ART in preventing new HIV infections has been confirmed by the HIV Prevention Trials Network (HPTN) 052 study, a two-arm, multi-site (nine countries) randomized trial on the effectiveness of treatment strategies among serodiscordant couples, which found that early initiation of ART results in a 96% reduction in sexual transmission [14]. HIV treatment as prevention (TasP) via early antiretroviral therapy (ART) has proven to reduce transmissions among HIV-serodiscordant couples, its full implementation in developing countries remains a challenge. We determine whether China’s current HIV treatment program prevents new HIV infections among discordant couples in rural China
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