Antiretroviral Therapy Greatly Cuts HIV Partner Transmission

For partner protection, low CD4 cell counts, high plasma HIV-1 concentrations could guide ART use
By Lindsey Marcellin
HealthDay Reporter

THURSDAY, May 27 (HealthDay News) -- In heterosexual HIV-1 patients, antiretroviral therapy (ART) can reduce the risk of HIV transmission to sexual partners by 92 percent, according to research published online May 27 in The Lancet.

Deborah Donnell, Ph.D., of the Fred Hutchinson Cancer Research Center in Seattle, and colleagues conducted a prospective cohort analysis of 3,381 heterosexual, HIV-1 serodiscordant African couples. All HIV-infected partners had CD4 counts of 250 cells/µL or greater at time of enrollment and did not meet national guidelines for ART; ART was initiated as the count dropped below 200 cells/µL.

Over the 24-month follow-up period, the researchers found that only one of 103 genetically-linked HIV-1 transmissions was from an infected partner who had started ART. The transmission rate was 0.37 per 100 person-years in those who had initiated treatment and 2.24 per 100 person-years in those who had not. After data adjustment, this corresponds to a 92-percent reduction in transmission in patients on ART. In participants not on ART, the highest HIV-1 transmission rate was 8.79 per 100 person-years, and it was found in those with CD4 counts of less than 200 cells/µL. In couples with an HIV-1-infected partner who had a CD4 cell count greater than 200 cells/µL, 70 percent of transmissions occurred when plasma HIV-1 concentrations were greater than 50,000 copies per mL.

"As countries strategize for optimum use of resources to expand ART provision beyond individuals with low CD4 cell counts, targeting of treatment to those with high plasma HIV-1 concentrations could be a cost-effective strategy to achieve maximum population-level reductions in HIV-1 transmission, as a step toward universal ART provision to all patients with HIV-1," the authors write.

Two authors disclosed financial ties to GlaxoSmithKline and one to Abbott Laboratories.

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