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

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

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Title: HIV-1 Subtype C-Infected Individuals Maintaining High Viral Load as Potential Targets for the “Test-and-Treat” Approach to Reduce HIV Transmission
Author: Baum, Marianna; Thior, Ibou; Asmelash, Aida; Campa, Adriana; van Widenfelt, Erik; Mine, Madisa; Moffat, Claire; Mmalane, Mompati; Gilbert, Peter; Novitsky, Vladimir A.; Wang, Rui; Bussmann, Hermann; Lockman, Shahin; Shapiro, Roger L.; Wester, Carolyn Negley; Wester, C William; Ogwu, Anthony; Musonda, Rosemary Mubanga; Moyo, Sikhulile; Makhema, Joseph Moeketsi; Marlink, Richard George; Seage, George R.; De Gruttola, Victor Gerard; Essex, Myron Elmer

Note: Order does not necessarily reflect citation order of authors.

Citation: Novitsky, Vladimir, Rui Wang, Hermann Bussmann, Shahin Lockman, Marianna Baum, Roger Shapiro, Ibou Thior, et al. 2010. HIV-1 Subtype C-Infected Individuals Maintaining High Viral Load as Potential Targets for the "Test-and-Treat" Approach to Reduce HIV Transmission. PLoS ONE 5:e10148.
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Abstract: 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 log10) and cART-initiating cohorts (5.1–5.3 log10) by about one log10. The proportion of individuals with high (≥50,000 (4.7 log10) 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 log10) 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.
Published Version: doi://10.1371/journal.pone.0010148
Other Sources: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2853582/pdf/
Terms of Use: This article is made available under the terms and conditions applicable to Other Posted Material, as set forth at http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAA
Citable link to this page: http://nrs.harvard.edu/urn-3:HUL.InstRepos:4515103
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