HIV-1 subtype C-infected individuals maintaining high viral load as potential targets for the "test-and-treat" approach to reduce HIV transmission.
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.
Novitsky
Vladimir
V
Harvard School of Public Health AIDS Initiative, Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America.
Wang
Rui
R
Bussmann
Hermann
H
Lockman
Shahin
S
Baum
Marianna
M
Shapiro
Roger
R
Thior
Ibou
I
Wester
Carolyn
C
Wester
C William
CW
Ogwu
Anthony
A
Asmelash
Aida
A
Musonda
Rosemary
R
Campa
Adriana
A
Moyo
Sikhulile
S
van Widenfelt
Erik
E
Mine
Madisa
M
Moffat
Claire
C
Mmalane
Mompati
M
Makhema
Joseph
J
Marlink
Richard
R
Gilbert
Peter
P
Seage
George R
GR
DeGruttola
Victor
V
Essex
M
M
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
D012367:RNA, Viral
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