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- Title
Risk of HIV transmission during combined ART initiation for HIV-infected persons with severe immunosuppression.
- Authors
Supervie, V.; Assoumou, L.; Costagliola, D.; Breban, R.; Lert, F.; Pialoux, G.; Slama, L.; Landman, R.; Girard, P. M.; IMEA 040 DATA Study Group
- Abstract
<bold>Background: </bold>Individuals presenting for care with severe immunosuppression typically have high plasma HIV viral load (pVL) and may transmit HIV before and after initiation of combination antiretroviral therapies (cART).<bold>Patients and Methods: </bold>Using risk equations and data collected in the IMEA 040 DATA trial on sexual behaviour and pVL level of 84 HIV-infected patients (23 women), we estimated monthly rates of HIV transmission for each virologically unsuppressed participant (pVL >50 copies/mL) who reported sex with HIV-negative or unknown serostatus (HNUS) partners at cART initiation, 24 weeks (W24) and W48 after; rates were considered negligible for other participants.<bold>Results: </bold>At cART initiation, median pVL was 5.4 log10 copies/mL. The percentage of virologically unsuppressed patients decreased, from 100% at cART initiation to 27% (95% CI 16%-43%) for heterosexuals and 8% (95% CI 2%-22%) for MSM at W48 (P < 0.001). The percentage of patients reporting sex with HNUS partners increased between cART initiation and W48, from 23% (95% CI 10%-42%) to 42% (95% CI 25%-61%) for heterosexuals (P = 0.042) and from 41% (95% CI 21%-64%) to 73% (95% CI 52%-88%) for MSM (P = 0.004). Median monthly HIV transmission rates were 0.0540 (IQR 0.0339-0.0742) for MSM and 0.0018 (IQR 0.0014-0.0191) for heterosexuals at cART initiation, and were reduced by 95% (95% CI 87%-100%) for heterosexuals and 98% (95% CI 95%-100%) for MSM as early as W24.<bold>Conclusions: </bold>Risk of onward transmission for severely immunosuppressed individuals is high before and within the first weeks of cART, and persists, at a substantially reduced level, beyond 24 weeks of cART for some individuals. Earlier cART and protecting HIV-negative partners until full viral suppression is achieved could reduce HIV transmission.
- Subjects
HIV infection transmission; IMMUNOSUPPRESSION; ANTIRETROVIRAL agents; VIRAL load; HUMAN sexuality; VIROLOGY
- Publication
Journal of Antimicrobial Chemotherapy (JAC), 2017, Vol 72, Issue 11, p3172
- ISSN
0305-7453
- Publication type
journal article
- DOI
10.1093/jac/dkx276