Advertisement

 

 

Antiretroviral therapy to prevent HIV acquisition in serodiscordant couples in a hyperendemic community in rural South Africa.

Author Information (click to view)

Oldenburg CE, Bärnighausen T, Tanser F, Iwuji CC, De Gruttola V, Seage GR, Mimiaga MJ, Mayer KH, Pillay D, Harling G,


Oldenburg CE, Bärnighausen T, Tanser F, Iwuji CC, De Gruttola V, Seage GR, Mimiaga MJ, Mayer KH, Pillay D, Harling G, (click to view)

Oldenburg CE, Bärnighausen T, Tanser F, Iwuji CC, De Gruttola V, Seage GR, Mimiaga MJ, Mayer KH, Pillay D, Harling G,

Advertisement
Share on FacebookTweet about this on TwitterShare on LinkedIn

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2016 5 20() pii

Abstract
BACKGROUND
 Antiretroviral therapy (ART) was highly efficacious in preventing HIV transmission in stable serodiscordant couples in the HPTN-052 study, a resource-rich randomized controlled trial. However, minimal evidence exists of the effectiveness of ART in preventing HIV acquisition in stable serodiscordant couples in real-life population-based settings in hyperendemic communities of Sub-Saharan Africa, where health systems are typically resource-poor and overburdened, adherence to ART is subpotimal, and HIV status disclosure to sexual partners is inconsistent.

METHODS
 Data arose from a population-based open cohort in KwaZulu-Natal, South Africa. HIV-uninfected individuals present between January 2005 and December 2013 (n=17,016) were included. Interval-censored time-updated proportional hazards regression was used to assess how the ART status affected HIV transmission risk in stable serodiscordant relationships.

RESULTS
 Of 17,016 individuals, 1,846 had an HIV-uninfected and 196 had an HIV-infected stable partner over the follow-up period. HIV incidence was 3.8 per 100 person-years (100PY) among individuals with an HIV-infected partner (95% confidence interval [CI] 2.3-5.6), corresponding to 1.4 per 100PY (95% CI 0.4-3.5) among those with HIV-infected partners on ART and 5.6 per 100PY (95% CI 3.5-8.4) among those with partners not on ART. Use of ART was associated with a 77% decrease in HIV acquisition risk amongst serodiscordant couples (aHR=0.23, 95% CI 0.07-0.80).

CONCLUSIONS
 ART initiation was associated with a very large reduction in HIV aquisition in serodiscordant couples in rural KwaZulu-Natal. However, real-life effectiveness was substantially lower than in the HPTN-052 trial. To eliminate HIV transmission in sero-discordant couples, additional prevention interventions are likely needed.

Submit a Comment

Your email address will not be published. Required fields are marked *

9 + 10 =

[ HIDE/SHOW ]