HIV-1 transmission among HIV-1 discordant couples before and after the introduction of antiretroviral therapy
HIV-1 transmission among HIV-1 discordant couples before and after the introduction of antiretroviral therapy
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DOI：
10.1097/qad.0b013e3283437c2b
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发表时间：
2011-02-20
期刊：
影响因子：
3.8
通讯作者：
Serwadda, David
中科院分区：
文献类型：
--
作者：
Reynolds, Steven J.;Makumbi, Frederick;Serwadda, David
目的：为了评估抗逆转录病毒治疗（ART）对HIV-1传播率之间的HIV-1不和谐夫妇在Rakai，Uganda.Design：Observational cohort study.Methods：HIV-1不和谐夫妇在2004年和2009年之间进行了回顾性研究。研究参与者每年接受HIV-1筛查，并接受采访以评估风险行为。参与者被提供自愿咨询和测试，并提供降低风险的咨询。向CD 4细胞计数为250个细胞/μ l或更少或WHO IV期疾病的参与者提供免费ART。比较HIV-1阳性指数伴侣开始ART前后HIV-1发病率和性危险行为。在2004年至2009年期间，对250对HIV-1不一致夫妇进行了随访，32名HIV-1阳性伴侣启动了ART。在ART启动前，42例HIV-1传播发生在459.4人-年以上，发生率为9.2/100人-年[95%置信区间（CI）6.59-12.36]。在32对HIV-1指数伴侣开始抗逆转录病毒治疗的夫妇中，在53.6人-年期间没有发生HIV-1传播。发生率差异的95% CI为-11.91至-6.38（P = 0.0097）。夫妇报告在ART使用期间更一致地使用避孕套，但在性伴侣数量或其他风险行为方面没有显着差异。病毒载量显着减少ART的人。结论：HIV-1传播可能会减少HIV-1不和谐的夫妇开始ART后，由于HIV-1病毒载量的减少和增加一致的避孕套使用。(C)2011威科健康垂直酒吧Lippincott威廉姆斯& Wilkins
Objective: To evaluate the impact of antiretroviral therapy (ART) on HIV-1 transmission rates among HIV-1 discordant couples in Rakai, Uganda.Design: Observational cohort study.Methods: HIV-1 discordant couples were retrospectively identified between 2004 and 2009. Study participants underwent annual screening for HIV-1 and were interviewed to evaluate risk behaviors. Participants were offered voluntary counseling and testing and provided with risk reduction counseling. Free ART was offered to participants with a CD4 cell count of 250 cells/mu l or less or WHO stage IV disease. HIV-1 incidence and sexual risk behaviors were compared before and after the HIV-1-positive index partners started ART.Results: Two hundred and fifty HIV-1 discordant couples were followed between 2004 and 2009 and 32 HIV-1-positive partners initiated ART. Forty-two HIV-1 transmissions occurred over 459.4 person-years prior to ART initiation, incidence 9.2/100 person-years [95% confidence interval (CI) 6.59-12.36]. In 32 couples in which the HIV-1 index partners started ART, no HIV-1 transmissions occurred during 53.6 person-years. The 95% CI for the incidence rate difference was -11.91 to -6.38 (P = 0.0097). Couples reported more consistent condom use during ART use, but there was no significant difference in the number of sexual partners or other risk behaviors. Viral load was markedly reduced in persons on ART.Conclusion: HIV-1 transmission may be reduced among HIV-1 discordant couples after initiation of ART due to reductions in HIV-1 viral load and increased consistent condom use. (C) 2011 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins