Antiretroviral therapy to prevent HIV transmission in serodiscordant couples in China (2003-11): a national observational cohort study
Antiretroviral therapy to prevent HIV transmission in serodiscordant couples in China (2003-11): a national observational cohort study
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DOI：
10.1016/s0140-6736(12)61898-4
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发表时间：
2013-10-05
期刊：
影响因子：
168.9
通讯作者：
Shao, Yiming
中科院分区：
文献类型：
--
作者：
Jia, Zhongwei;Mao, Yurong;Shao, Yiming
背景：根据随机临床试验HPTN 052和观察性研究的结果，世卫组织建议对所有有未感染异性伴侣（血清不一致的夫妇）的艾滋病毒感染者停止抗逆转录病毒治疗，以降低传播风险。这种公共卫生方法在大规模和发展中国家环境中是否可行，其结果是否可持续，以前没有得到评估。方法在这项回顾性观察队列研究中，我们纳入了2003年1月1日至2011年12月31日期间加入国家艾滋病毒流行病学和治疗数据库的HIV阳性患者和HIV阴性异性伴侣。我们分析了随访期间艾滋病毒阴性伴侣的年艾滋病毒感染率，按指标伴侣的治疗状况分层。进行Cox比例风险分析以检查与HIV传播相关的因素。基于38 862对血清不一致夫妇的数据，以及对血清阴性伴侣的101 295.1人年的随访，在未接受治疗的14805对夫妇中，HIV感染率为2.6 / 100人年（95% CI 2.4-2.8） （HIV阳性伴侣的中位基线CD4细胞计数为441个/亩[IQR 314-590]），而在接受治疗的24057对夫妇中，HIV阳性伴侣的中位基线CD4细胞计数为168个/亩[IQR 314-590])， HIV感染率为1.3 / 100人年（1.2-1.3）。我们计算出，在接受治疗的队列中，HIV传播相对减少了26%（校正风险比0.74,95% CI 0.65-0.84）。在几乎所有的人口亚组中都可以看到传播的减少，并且在第一年（0.64,0.54-0.76）以及艾滋病毒阳性伴侣通过输血或血浆感染（0.76,0.59-0.99）或异性性交感染（0.69,0.56-0.84）的夫妇中都有显著的减少，但在艾滋病毒阳性伴侣通过注射药物感染的夫妇中没有（0.98,0.71-1.36）。对血清不一致夫妇中艾滋病毒阳性个体进行抗逆转录病毒治疗减少了中国各地的艾滋病毒传播，这表明在发展中国家，治疗即预防是一种可行的全国性公共卫生预防策略。然而，这种保护的耐久性和通用性需要进一步研究。
Background On the basis of the results of the randomised clinical trial HPTN 052 and observational studies, WHO has recommended that antiretroviral therapy be off ered to all HIV-infected individuals with uninfected partners of the opposite sex (serodiscordant couples) to reduce the risk of transmission. Whether or not such a public health approach is feasible and the outcomes are sustainable at a large scale and in a developing country setting has not previously been assessed.Methods In this retrospective observational cohort study, we included treated and treatment-naive HIV-positive individuals with HIV-negative partners of the opposite sex who had been added to the national HIV epidemiology and treatment databases between Jan 1, 2003 and Dec 31, 2011. We analysed the annual rate of HIV infection in HIVnegative partners during follow-up, stratifi ed by treatment status of the index partner. Cox proportional hazards analyses were done to examine factors related to HIV transmission.Findings Based on data from 38 862 serodiscordant couples, with 101 295.1 person-years of follow-up for the seronegative partners, rates of HIV infection were 2.6 per 100 person-years (95% CI 2.4-2.8) among the 14 805 couples in the treatment-naive cohort (median baseline CD4 count for HIV-positive partners 441 cells per mu l [IQR 314-590]) and 1.3 per 100 person-years (1.2-1.3) among the 24 057 couples in the treated cohort (median baseline CD4 count for HIV-positive partners 168 cells per mu l [62-269]). We calculated a 26% relative reduction in HIV transmission (adjusted hazard ratio 0.74, 95% CI 0.65-0.84) in the treated cohort. The reduction in transmission was seen across almost all demographic subgroups and was signifi cant in the fi rst year (0.64, 0.54-0.76), and among couples in which the HIV-positive partner had been infected by blood or plasma transfusion (0.76, 0.59-0.99) or heterosexual intercourse (0.69, 0.56-0.84), but not among couples in which the HIV-positive partner was infected by injecting drugs (0.98, 0.71-1.36).Interpretation Antiretroviral therapy for HIV-positive individuals in serodiscordant couples reduced HIV transmission across China, which suggests that the treatment-as-prevention approach is a feasible public health prevention strategy on a national scale in a developing country context. The durability and generalisability of such protection, however, needs to be further studied.