Antiretroviral therapy reduces HIV transmission in discordant couples in rural Yunnan, China

Na He, Song Duan, Yingying Ding, Keming Rou, Jennifer M McGoogan, Manhong Jia, Yuecheng Yang, Jibao Wang, Julio S G Montaner, Zunyou Wu, China National HIV Prevention Study Group, Zunyou Wu, Keming Rou, Na He, Wenyuan Yin, Jie Xu, Lin Pang, Jianhua Li, Xiangdong Ming, Fan Li, Wei Liu, Linlin Zhang, Limei Shen, Minghua Zhuang, Liangui Feng, Hongbo Zhang, Yehuan Sun, Zunyou Wu, Keming Rou, Na He, Haiying Fan, Na He, Zhuohua Fu, Yingying Ding, Manhong Jia, Song Duan, Yuecheng Yang, Yunhua Ye, Lin Pang, Enwu Liu, Yehuan Sun, Na He, Song Duan, Yingying Ding, Keming Rou, Jennifer M McGoogan, Manhong Jia, Yuecheng Yang, Jibao Wang, Julio S G Montaner, Zunyou Wu, China National HIV Prevention Study Group, Zunyou Wu, Keming Rou, Na He, Wenyuan Yin, Jie Xu, Lin Pang, Jianhua Li, Xiangdong Ming, Fan Li, Wei Liu, Linlin Zhang, Limei Shen, Minghua Zhuang, Liangui Feng, Hongbo Zhang, Yehuan Sun, Zunyou Wu, Keming Rou, Na He, Haiying Fan, Na He, Zhuohua Fu, Yingying Ding, Manhong Jia, Song Duan, Yuecheng Yang, Yunhua Ye, Lin Pang, Enwu Liu, Yehuan Sun

Abstract

Background: Although HIV treatment as prevention (TasP) via early antiretroviral therapy (ART) has proven to reduce transmissions among HIV-serodiscordant couples, its full implementation in developing countries remains a challenge. In this study, we determine whether China's current HIV treatment program prevents new HIV infections among discordant couples in rural China.

Methods: A prospective, longitudinal cohort study was conducted from June 2009 to March 2011, in rural Yunnan. A total of 1,618 HIV-discordant couples were eligible, 1,101 were enrolled, and 813 were followed for an average of 1.4 person-years (PY). Routine ART was prescribed to HIV-positive spouses according to eligibility (CD4<350 cells/µl). Seroconversion was used to determine HIV incidence.

Results: A total of 17 seroconversions were documented within 1,127 PY of follow-up, for an overall incidence of 1.5 per 100 PY. Epidemiological and genetic evidence confirmed that all 17 seroconverters were infected via marital secondary sexual transmission. Having an ART-experienced HIV-positive partner was associated with a lower rate of seroconvertion compared with having an ART-naïve HIV-positive partner (0.8 per 100 PY vs. 2.4 per 100 PY, HR = 0.34, 95%CI = 0.12-0.97, p = 0.0436). While we found that ART successfully suppressed plasma viral load to <400 copies/ml in the majority of cases (85.0% vs. 19.5%, p<0.0001 at baseline), we did document five seroconversions among ART-experienced subgroup.

Conclusions: ART is associated with a 66% reduction in HIV incidence among discordant couples in our sample, demonstrating the effectiveness of China's HIV treatment program at preventing new infections, and providing support for earlier ART initiation and TasP implementation in this region.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Flow chart depicting the development…
Figure 1. Flow chart depicting the development of the cohort of HIV-discordant couples who participated in this study of HIV discordant couples in rural Yunnan, China, 2009–2011.

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