title: Treatment to Prevent HIV Transmission in Serodiscordant Couples in Henan, China, 2006 to 2012.
abstract: BACKGROUND
  Antiretroviral therapy (ART) administered in clinical trial settings virtually eliminates the sexual transmission of human immunodeficiency virus (HIV) in serodiscordant couples, but effectiveness of treatment as prevention in the community is debated. Conflicting results from previous analyses in a Chinese cohort underscore the importance of determining effectiveness of ART delivered in resource limited settings.
  
  
  METHODS
  All available years of data (2006-2012) from local disease control records of HIV patients and their seronegative spouses in Henan Province, China, were analyzed using marginal structural Cox models to estimate the effect of ART in the initially infected partner his or her partner's HIV seroconversion risk.
  
  
  RESULTS
  We observed 157 seroconversion events in 4916 serosdiscordant couples, for an incidence rate of 0.59 cases per 100 person-years (PY) (95% confidence interval [CI], .51-.70). Of these, 84 occurred after the index partner had initiated ART (0.43/100PY; 95% CI, .35-.53) and 73, whereas index partners were untreated (5.87/100 PY; 95% CI, 4.65-7.42). In a marginal structural Cox model weighted for confounding and censoring, the hazard ratio (HR) for HIV transmission was 0.52 (95% CI, .34-.82). ART efficacy varied significantly by time period; least effective in the early phase from 2006 to 2008 (HR, 0.68; 95% CI, .34-1.36) but far more protective from 2009 onward (HR, 0.33; 95% CI, .20-.55).
  
  
  CONCLUSIONS
  ART can provide HIV-infected persons in resource-limited setting substantial protection against sexual transmission. Effectiveness in the Henan cohort appears to have increased over time, suggesting that quality of care and service infrastructure may be integral to successful use of treatment for prevention.
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill National Center for AIDS/STD Control and Prevention.
authors.forename: M Kumi
authors.initials: MK
authors.lastname: Smith
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill.
authors.forename: Daniel
authors.initials: D
authors.lastname: Westreich
authors.affiliation: National Center for AIDS/STD Control and Prevention.
authors.forename: Huixin
authors.initials: H
authors.lastname: Liu
authors.affiliation: National Center for AIDS/STD Control and Prevention.
authors.forename: Lin
authors.initials: L
authors.lastname: Zhu
authors.affiliation: National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing.
authors.forename: Lan
authors.initials: L
authors.lastname: Wang
authors.affiliation: Zhumadian Centre for Disease Control and Prevention, Henan Province, China.
authors.forename: Wensheng
authors.initials: W
authors.lastname: He
authors.affiliation: Zhumadian Centre for Disease Control and Prevention, Henan Province, China.
authors.forename: Jianping
authors.initials: J
authors.lastname: Zhou
authors.affiliation: Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill.
authors.forename: William C
authors.initials: WC
authors.lastname: Miller
authors.affiliation: Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill.
authors.forename: Myron S
authors.initials: MS
authors.lastname: Cohen
authors.affiliation: National Center for AIDS/STD Control and Prevention.
authors.forename: Ning
authors.initials: N
authors.lastname: Wang
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005191:Family Characteristics; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment
chemical_list: D044966:Anti-Retroviral Agents
keywords: China; HIV treatment as prevention; HIV/AIDS; serodiscordant couples; sexual transmission