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ART reduced HIV transmission among poor, serodiscordant couples
Antiretroviral therapy appears to provide significant protection against sexual transmission for serodiscordant couples in resource-limited areas, according to recent data.
Researchers evaluated 4,916 couples enrolled in the Henan HIV serodiscordant couple cohort between 2006 and 2012. Couples eligible for inclusion in the study were residents of Henan, China, aged 16 years and older, in a stable marriage and in an HIV serodiscordant relationship upon enrollment. Each couple was seen for at least two study visits and completed annual surveys that included private and separate face-to-face interviews for each partner.
In the surveys, participants answered questions related to demographics and behaviors over the previous year, including sexual contact both inside and outside the primary relationship, diagnosis of sexually transmitted infections, drug use and history of travel or relocation for work. The partner with HIV at baseline provided further medical history, including ART use. Initially uninfected partners were tested for HIV antibodies, with those who tested positive referred to their local disease control centers for confirmation and treatment eligibility evaluation.
The study’s primary outcome was time to seroconversion in the uninfected partner. Seroconversion was defined as the midpoint between the last HIV-negative or indeterminate test and 3 months prior to the first HIV-positive test.
There 157 seroconversion events among the couples throughout the study period, equaling an incidence rate of 0.59 cases per 100 person-years (95% CI, 0.51-0.70). Eighty-four of these events occurred after the originally infected partner had initiated ART (0.43 per 100 person-years; 95% CI, 0.35-0.54), and 73 occurred while the originally infected partners were not treated (5.87 per 100 person years; 95% CI, 4.65-7.42).
A marginal structural Cox model, weighted for confounding and censoring, revealed a hazard ratio for HIV transmission of 0.52 (95% CI, 0.34-0.82). There was a significant variation in ART efficacy based on time period, with early phase (2006-2008) ART being the least effective (HR = 0.68; 95% CI, 0.34-1.36). ART also was found to be much more effective in protecting against HIV infection from 2009 onward (HR = 0.33; 95% CI, 0.20-0.55).
“We find that ART treatment of infected patients reduced HIV transmission,” the researchers wrote. “The magnitude and durability of benefit will depend on availability of well tolerated antiretroviral agents, a sufficient health care infrastructure, and constant adherence to medication. The experience in China suggests that these requirements can be met even in poor and remote locations.” – by Jen Byrne
Disclosure: The researchers report no relevant financial disclosures.