HIV-1 Subtype C-Infected Individuals Maintaining High Viral Load as Potential Targets for the "Test-and-Treat'' Approach to Reduce HIV Transmission

被引:46
作者
Novitsky, Vladimir [1 ,2 ]
Wang, Rui [3 ]
Bussmann, Hermann [1 ,2 ]
Lockman, Shahin [1 ,2 ]
Baum, Marianna [4 ]
Shapiro, Roger [1 ,2 ]
Thior, Ibou [1 ,2 ]
Wester, Carolyn [1 ,2 ]
Wester, C. William [1 ,2 ,8 ]
Ogwu, Anthony [1 ,2 ]
Asmelash, Aida [1 ,2 ]
Musonda, Rosemary [1 ,2 ]
Campa, Adriana [4 ]
Moyo, Sikhulile [2 ]
van Widenfelt, Erik [2 ]
Mine, Madisa [2 ]
Moffat, Claire [1 ,2 ]
Mmalane, Mompati [2 ]
Makhema, Joseph [1 ,2 ]
Marlink, Richard [1 ,2 ]
Gilbert, Peter [5 ,6 ]
Seage, George R., III [7 ]
DeGruttola, Victor [3 ]
Essex, M. [1 ,2 ]
机构
[1] Harvard Univ, Sch Publ Hlth, AIDS Initiat, Dept Immunol & Infect Dis, Boston, MA 02115 USA
[2] Botswana Harvard AIDS Inst Partnership, Gaborone, Botswana
[3] Harvard Univ, Sch Publ Hlth, Dept Biostat, Boston, MA 02115 USA
[4] Florida Int Univ, Dept Nutr & Dietet, Robert R Stempel Sch Publ Hlth, Miami, FL 33199 USA
[5] Univ Washington, Dept Biostat, Seattle, WA 98195 USA
[6] Fred Hutchinson Canc Res Ctr, Seattle, WA 98104 USA
[7] Harvard Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA 02115 USA
[8] Vanderbilt Univ, Sch Med, Div Infect Dis, VIGH, Nashville, TN 37212 USA
关键词
HUMAN-IMMUNODEFICIENCY-VIRUS; RANDOMIZED CLINICAL-TRIAL; ANTIRETROVIRAL THERAPY; HETEROSEXUAL TRANSMISSION; TYPE-1; INFECTION; NATURAL-HISTORY; SOUTHERN AFRICA; RISK-FACTORS; RNA LEVELS; BOTSWANA;
D O I
10.1371/journal.pone.0010148
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
The first aim of the study is to assess the distribution of HIV-1 RNA levels in subtype C infection. Among 4,348 drug-naive 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 (>= 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 >= 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.
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页数:10
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