title: HIV-1 subtype C-infected individuals maintaining high viral load as potential targets for the "test-and-treat" approach to reduce HIV transmission.
abstract: The first aim of the study is to assess the distribution of HIV-1 RNA levels in subtype C infection. Among 4,348 drug-naïve HIV-positive individuals participating in clinical studies in Botswana, the median baseline plasma HIV-1 RNA levels differed between the general population cohorts (4.1-4.2 log(10)) and cART-initiating cohorts (5.1-5.3 log(10)) by about one log(10). The proportion of individuals with high (> or = 50,000 (4.7 log(10)) copies/ml) HIV-1 RNA levels ranged from 24%-28% in the general HIV-positive population cohorts to 65%-83% in cART-initiating cohorts. The second aim is to estimate the proportion of individuals who maintain high HIV-1 RNA levels for an extended time and the duration of this period. For this analysis, we estimate the proportion of individuals who could be identified by repeated 6- vs. 12-month-interval HIV testing, as well as the potential reduction of HIV transmission time that can be achieved by testing and ARV treating. Longitudinal analysis of 42 seroconverters revealed that 33% (95% CI: 20%-50%) of individuals maintain high HIV-1 RNA levels for at least 180 days post seroconversion (p/s) and the median duration of high viral load period was 350 (269; 428) days p/s. We found that it would be possible to identify all HIV-infected individuals with viral load > or = 50,000 (4.7 log(10)) copies/ml using repeated six-month-interval HIV testing. Assuming individuals with high viral load initiate cART after being identified, the period of high transmissibility due to high viral load can potentially be reduced by 77% (95% CI: 71%-82%). Therefore, if HIV-infected individuals maintaining high levels of plasma HIV-1 RNA for extended period of time contribute disproportionally to HIV transmission, a modified "test-and-treat" strategy targeting such individuals by repeated HIV testing (followed by initiation of cART) might be a useful public health strategy for mitigating the HIV epidemic in some communities.
authors.affiliation: Harvard School of Public Health AIDS Initiative, Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Novitsky
authors.forename: Rui
authors.initials: R
authors.lastname: Wang
authors.forename: Hermann
authors.initials: H
authors.lastname: Bussmann
authors.forename: Shahin
authors.initials: S
authors.lastname: Lockman
authors.forename: Marianna
authors.initials: M
authors.lastname: Baum
authors.forename: Roger
authors.initials: R
authors.lastname: Shapiro
authors.forename: Ibou
authors.initials: I
authors.lastname: Thior
authors.forename: Carolyn
authors.initials: C
authors.lastname: Wester
authors.forename: C William
authors.initials: CW
authors.lastname: Wester
authors.forename: Anthony
authors.initials: A
authors.lastname: Ogwu
authors.forename: Aida
authors.initials: A
authors.lastname: Asmelash
authors.forename: Rosemary
authors.initials: R
authors.lastname: Musonda
authors.forename: Adriana
authors.initials: A
authors.lastname: Campa
authors.forename: Sikhulile
authors.initials: S
authors.lastname: Moyo
authors.forename: Erik
authors.initials: E
authors.lastname: van Widenfelt
authors.forename: Madisa
authors.initials: M
authors.lastname: Mine
authors.forename: Claire
authors.initials: C
authors.lastname: Moffat
authors.forename: Mompati
authors.initials: M
authors.lastname: Mmalane
authors.forename: Joseph
authors.initials: J
authors.lastname: Makhema
authors.forename: Richard
authors.initials: R
authors.lastname: Marlink
authors.forename: Peter
authors.initials: P
authors.lastname: Gilbert
authors.forename: George R
authors.initials: GR
authors.lastname: Seage
authors.forename: Victor
authors.initials: V
authors.lastname: DeGruttola
authors.forename: M
authors.initials: M
authors.lastname: Essex
mesh_terms: D000818:Animals; D001902:Botswana; D003710:Demography; D058872:Epidemics / Q000517:prevention & control*; D015658:HIV Infections / Q000175:diagnosis / Q000628:therapy / Q000635:transmission*; D006679:HIV Seropositivity; D015497:HIV-1 / Q000145:classification*; D008137:Longitudinal Studies; D008403:Mass Screening / Q000379:methods*; D012367:RNA, Viral / Q000097:blood; D013997:Time Factors; D019562:Viral Load
chemical_list: D012367:RNA, Viral
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