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ART Reduced the Rate of Sexual Transmission of HIV among HIV-discordant Couples in Rural Rakai, Uganda
Steven Reynolds*1,2, F Makumbi3, J Kagaayi4, G Nakigozi4, R Galiwongo4, T Quinn1,2, M Wawer5, R Gray5, and D Serwadda3
1NIAID, NIH, Bethesda, MD, US; 2Johns Hopkins Univ Sch of Med, Baltimore, MD, US; 3Makerere Univ Sch of Publ Hlth, Kampala, Uganda; 4Rakai Hlth Sci Prgm, Entebbe, Uganda; and 5Johns Hopkins Univ Bloomberg Sch of Publ Hlth, Baltimore, MD, US
Background:
ART may contribute to comprehensive HIV prevention efforts. We evaluated
the influence of ART on HIV transmission in stable HIV-1-discordant couples in
our HIV treatment program in Rakai, Uganda.
Methods:
Free ART was offered to Rakai program participants beginning in June 2004,
eligibility criteria included CD4 <250 cells/mm3 or WHO (World
Health Organization) stage IV disease. HIV-discordant couples participating in
the Rakai Community Cohort Study were surveyed annually for incident HIV
infection (in the HIV– partner), and were administered a structured
questionnaire to assess behavioral HIV risk factors. HIV incidence,
sociodemographics, and HIV risk behaviors were compared between couples during
periods before and after the HIV+ partner was started on ART.
Results:
From June 2004 through October 2007, 193 couples were identified as being in
an HIV-discordant relationship, and 20 of these couples were started on ART
during this same period (12 index male and 8 index female positives). The
median (IQR) follow-up time was 1.50 years (1.40 to 1.67); 1.52 (1.42 to 1.67)
not on ART; and 1.13 (0.54 to 1.65) years on ART. A total of 32 HIV
transmissions in 372.1 person-years occurred during the non-ART follow-up
period, resulting in an incidence of 8.6 per 100 person-years (95%CI 5.9 to 12.1).
No HIV transmissions occurred among couples during the 24.6 person-years they
were on ART: 14 index partners, prior to ART initiation, had a median baseline
viral load of 43,927 copies/mL (IQR 3306 to 465,664); of 19 individuals on ART,
15 (79%) at 6 months had achieved a viral load below detectable levels (<400
copies/mL); and of 20 individuals, 19 (95%) achieved at least 1 viral load
below detectable levels within the first 18 months of treatment. No significant
difference in sexual behaviors (number of partners, condom use, alcohol use
before sex), and self-reported genital ulcer disease were observed between
couples during the period while on or off ART.
Conclusions:
ART reduced HIV transmission among discordant couples during the period ART
was provided free in this rural treatment cohort.
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