High Transmitter CD4+ T-Cell Count Shortly after the Time of Transmission in a Study of African Serodiscordant Couples.
BACKGROUND
2013 WHO guidelines recommend starting ART at CD4+ T-cell counts ≤500 cells/μL. We present the T-cell counts from adult Africans with HIV shortly following transmission to their sexual partners.


METHODS
HIV-discordant couples in Zambia, Uganda and Rwanda were followed prospectively and received couples counseling and condoms. HIV uninfected partners were tested for HIV at least quarterly and HIV-infected partners received HIV care and referral for ART per national guidelines. Upon diagnosis of incident HIV infection in the previously HIV-uninfected partner, a blood sample was collected from both partners to measure CD4+ T-cells and perform viral linkage. The estimated date of infection (EDI) of the incident case was calculated based on testing history. EDI was unknown for suspected transmitting partners.


RESULTS
From 2006-2011, 4,705 HIV-discordant couples were enrolled in this cohort, and 443 cases of incident HIV infection were documented. Virus linkage analysis was performed in 374 transmission pairs, and 273 (73%) transmissions were linked genetically. CD4 counts in the transmitting partner were measured a median of 56 days after EDI (mean:90.5, min:10, max:396). The median CD4 count was 339 cells/μl (mean:386.4, min:15, max:1,434), and the proportion of partners with a CD4+ T-cell count above 500/μl was 25% (95% CI:21, 31).


CONCLUSIONS
In our cohort of discordant couples, 73% of HIV transmissions occurred within the relationship, and the transmitter CD4+ T cell count shortly after the transmission event was frequently higher than the WHO 2013 ART-initiation guidelines.
Projet San Francisco, Kigali, Rwanda.
Etienne
E
Karita
International AIDS Vaccine Initiative (IAVI), New York, New York, United States of America; UCSF Department of Epidemiology and Biostatistics, San Francisco, California, United States of America.
Matt A
MA
Price
Zambia Emory HIV Research Project, Lusaka, Ndola and Kitwe, Zambia.
Shabir
S
Lakhi
Zambia Emory HIV Research Project, Lusaka, Ndola and Kitwe, Zambia.
William
W
Kilembe
Medical Research Council/Uganda Virus Research Institute, Masaka and Entebbe, Uganda.
Anatoli
A
Kamali
Medical Research Council/Uganda Virus Research Institute, Masaka and Entebbe, Uganda.
Eugene
E
Ruzagira
Projet San Francisco, Kigali, Rwanda; Zambia Emory HIV Research Project, Lusaka, Ndola and Kitwe, Zambia; Emory Vaccine Center, Emory University, Atlanta, Georgia, United States of America.
Eric
E
Hunter
Emory Vaccine Center, Emory University, Atlanta, Georgia, United States of America.
Paul
P
Farmer
School of Medicine, Emory University, Atlanta, Georgia, United States of America.
Susan
S
Allen
Human Immunology Laboratory, IAVI, London, United Kingdom.
Gwynn
G
Stevens
Human Immunology Laboratory, IAVI, London, United Kingdom.
Paramesh
P
Chetty
International AIDS Vaccine Initiative (IAVI), New York, New York, United States of America.
Sabrina
S
Welsh
International AIDS Vaccine Initiative (IAVI), New York, New York, United States of America.
Annie
A
Yang
Human Immunology Laboratory, IAVI, London, United Kingdom.
Jill
J
Gilmour
International AIDS Vaccine Initiative (IAVI), New York, New York, United States of America.
Pat
P
Fast
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology / Q000821:virology; D015331:Cohort Studies; D005191:Family Characteristics; D005260:Female; D006678:HIV / Q000276:immunology / Q000302:isolation & purification / Q000502:physiology; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology* / Q000635:transmission*; D006801:Humans; D008297:Male; D012432:Rwanda / Q000453:epidemiology; D012747:Sexual Partners; D014454:Uganda / Q000453:epidemiology; D019562:Viral Load / Q000187:drug effects; D015024:Zambia / Q000453:epidemiology
D019380:Anti-HIV Agents