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dc.contributor.authorBaum, Marianna
dc.contributor.authorThior, Ibou
dc.contributor.authorAsmelash, Aida
dc.contributor.authorCampa, Adriana
dc.contributor.authorvan Widenfelt, Erik
dc.contributor.authorMine, Madisa
dc.contributor.authorMoffat, Claire
dc.contributor.authorMmalane, Mompati
dc.contributor.authorGilbert, Peter
dc.contributor.authorNovitsky, Vladimir A.
dc.contributor.authorWang, Rui
dc.contributor.authorBussmann, Hermann
dc.contributor.authorLockman, Shahin
dc.contributor.authorShapiro, Roger L.
dc.contributor.authorWester, Carolyn Negley
dc.contributor.authorWester, C William
dc.contributor.authorOgwu, Anthony
dc.contributor.authorMusonda, Rosemary Mubanga
dc.contributor.authorMoyo, Sikhulile
dc.contributor.authorMakhema, Joseph Moeketsi
dc.contributor.authorMarlink, Richard George
dc.contributor.authorSeage, George R.
dc.contributor.authorDe Gruttola, Victor Gerard
dc.contributor.authorEssex, Myron Elmer
dc.date.accessioned2010-11-01T18:56:02Z
dc.date.issued2010
dc.identifier.citationNovitsky, 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.en_US
dc.identifier.issn1932-6203en_US
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:4515103
dc.description.abstractThe 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.en_US
dc.language.isoen_USen_US
dc.publisherPublic Library of Scienceen_US
dc.relation.isversionofdoi://10.1371/journal.pone.0010148en_US
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2853582/pdf/en_US
dash.licenseLAA
dc.subjectvirologyen_US
dc.subjectdiagnosisen_US
dc.subjectimmunodeficiency virusesen_US
dc.subjectinfectious diseasesen_US
dc.subjectepidemiology and control of infectious diseasesen_US
dc.subjectHIV infection and AIDSen_US
dc.subjectviral infectionsen_US
dc.subjectpublic health and epidemiologyen_US
dc.subjectepidemiologyen_US
dc.subjectpreventive medicineen_US
dc.subjectscreeningen_US
dc.titleHIV-1 Subtype C-Infected Individuals Maintaining High Viral Load as Potential Targets for the “Test-and-Treat” Approach to Reduce HIV Transmissionen_US
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden_US
dc.relation.journalPLoS ONEen_US
dash.depositing.authorShapiro, Roger L.
dc.date.available2010-11-01T18:56:02Z
dash.affiliation.otherSPH^Immunology and Infectious Diseasesen_US
dash.affiliation.otherSPH^HSPH AIDS Initiativesen_US
dash.affiliation.otherSPH^Immunology and Infectious Diseasesen_US
dash.affiliation.otherSPH^Immunology and Infectious Diseasesen_US
dash.affiliation.otherSPH^Immunology and Infectious Diseasesen_US
dash.affiliation.otherSPH^Immunology and Infectious Diseasesen_US
dash.affiliation.otherSPH^Immunology and Infectious Diseasesen_US
dash.affiliation.otherSPH^Immunology and Infectious Diseasesen_US
dash.affiliation.otherSPH^HSPH AIDS Initiativesen_US
dash.affiliation.otherSPH^Epidemiologyen_US
dash.affiliation.otherSPH^Immunology and Infectious Diseasesen_US
dc.identifier.doi10.1371/journal.pone.0010148*
dash.authorsorderedfalse
dash.contributor.affiliatedWester, Carolyn
dash.contributor.affiliatedDeGruttola, Victor
dash.contributor.affiliatedOgwu, Anthony
dash.contributor.affiliatedEssex, Myron
dash.contributor.affiliatedWang, Rui
dash.contributor.affiliatedShapiro, Roger
dash.contributor.affiliatedNovitsky, Vladimir
dash.contributor.affiliatedMusonda, Rosemary
dash.contributor.affiliatedMakhema, Joseph
dash.contributor.affiliatedBussmann, Hermann
dash.contributor.affiliatedMarlink, Richard
dash.contributor.affiliatedWester, C
dash.contributor.affiliatedMoyo, Sikhulile
dash.contributor.affiliatedSeage, George
dash.contributor.affiliatedLockman, Shahin


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