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Clin Infect Dis. 2016 Aug 15;63(4):548-54. doi: 10.1093/cid/ciw335. Epub 2016 May 20.

Antiretroviral Therapy to Prevent HIV Acquisition in Serodiscordant Couples in a Hyperendemic Community in Rural South Africa.

Author information

1
Department of Epidemiology.
2
Department of Global Health and Population Africa Centre for Population Health, Mtubatuba.
3
Africa Centre for Population Health, Mtubatuba Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
4
Africa Centre for Population Health, Mtubatuba.
5
Department of Biostatistics, Harvard T. H. Chan School of Public Health.
6
Department of Epidemiology Department of The Fenway Institute, Fenway Community Health Departments of Behavioral and Social Sciences and Epidemiology, Institute for Community Health Promotion, Brown University School of Public Health, Providence, Rhode Island.
7
Department of Global Health and Population Department of The Fenway Institute, Fenway Community Health Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
8
Africa Centre for Population Health, Mtubatuba Division of Infection & Immunity, University College London, United Kingdom.

Abstract

BACKGROUND:

Antiretroviral therapy (ART) was highly efficacious in preventing human immunodeficiency virus (HIV) transmission in stable serodiscordant couples in the HPTN-052 study, a resource-intensive randomized controlled trial with near-perfect ART adherence and mutual HIV status disclosure among all participating couples. 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 often low, and partners commonly do not disclose their HIV status to each other.

METHODS:

Data arose from a population-based open cohort in KwaZulu-Natal, South Africa. A total of 17 016 HIV-uninfected individuals present between January 2005 and December 2013 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:

We observed 1619 HIV seroconversions in 17 016 individuals, over 60 349 person-years follow-up time. During the follow-up period, 1846 individuals had an HIV-uninfected and 196 had an HIV-infected stable partner HIV incidence was 3.8/100 person-years (PY) among individuals with an HIV-infected partner (95% confidence interval [CI], 2.3-5.6), 1.4/100 PY (.4-3.5) among those with HIV-infected partners receiving ART, and 5.6/100 PY (3.5-8.4) among those with HIV-infected partners not receiving ART. Use of ART was associated with a 77% decrease in HIV acquisition risk among serodiscordant couples (adjusted hazard ratio, 0.23; 95% CI, .07-.80).

CONCLUSIONS:

ART initiation was associated with a very large reduction in HIV acquisition in serodiscordant couples in rural KwaZulu-Natal. However, this "real-life" effect was substantially lower than the effect observed in the HPTN-052 trial. To eliminate HIV transmission in serodiscordant couples, additional prevention interventions are probably needed.

KEYWORDS:

HIV; South Africa; antiretroviral therapy; serodiscordant couples; treatment as prevention

PMID:
27208044
PMCID:
PMC4967606
DOI:
10.1093/cid/ciw335
[Indexed for MEDLINE]
Free PMC Article

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