CDC-Uganda, National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention, Entebbe, Uganda.
AIDS. 2011 Jun 19;25(10):1317-27. doi: 10.1097/QAD.0b013e328347f775.
Long-term impact of antiretroviral therapy (ART) on sexual HIV-transmission risk in Africa is unknown. We assessed sexual behavior changes and estimated HIV transmission from HIV-infected adults on ART in Uganda.
Between 2003 and 2007, we enrolled and followed ART-naive HIV-infected adults in a home-based AIDS program with annual counseling and testing for cohabitating partners, participant transmission risk-reduction plans, condom distribution and prevention support for cohabitating discordant couples. We assessed participants' HIV plasma viral load and partner-specific sexual behaviors. We defined risky sex as intercourse with inconsistent/no condom use with HIV-negative or unknown serostatus partners in previous 3 months. We compared rates using Poisson regression models, estimated transmission risk using established viral load-specific transmission estimates, and documented sero-conversion rates among HIV-discordant couples.
Of 928 participants, 755 (81%) had 36 months data: 94 (10%) died and 79 (9%) missing data. Sexual activity increased from 28% (baseline) to 41% [36 months (P < 0.001)]. Of sexually active participants, 22% reported risky sex at baseline, 8% at 6 months (P < 0.001), and 14% at 36 months (P = 0.018). Median viral load among those reporting risky sex was 122,500 [interquartile range (IQR) 45 100-353 000] copies/ml pre-ART at baseline and undetectable at follow-up. One sero-conversion occurred among 62 cohabitating sero-discordant partners (0.5 sero-conversions/100 person-years). At 36 months, consistent condom use was 74% with discordant partners, 55% with unknown and 46% with concordant partners. Estimated HIV transmission risk reduced 91%, from 47.3 to 4.2/1000 person-years.
Despite increased sexual activity among HIV-infected Ugandans over 3 years on ART, risky sex and estimated risk of HIV transmission remained lower than baseline levels. Integrated prevention programs could reduce HIV transmission in Africa.
抗逆转录病毒疗法（ART）对非洲艾滋病毒传播风险的长期影响尚不清楚。我们评估了乌干达接受 ART 的艾滋病毒感染者的性行为变化，并估计了 HIV 传播情况。
2003 年至 2007 年，我们招募并随访了接受基于家庭的艾滋病项目的抗逆转录病毒治疗初治的 HIV 感染者，该项目每年对同居伴侣进行咨询和检测，为参与者制定减少传播风险的计划，发放避孕套，并为不和谐的夫妇提供预防支持。我们评估了参与者的 HIV 血浆病毒载量和特定伴侣的性行为。我们将不安全的性行为定义为在过去 3 个月内与 HIV 阴性或未知血清状态的伴侣发生无保护措施或保护措施不一致的性行为。我们使用泊松回归模型比较了这些比率，利用既定的病毒载量特异性传播估计数计算了传播风险，并记录了 HIV 不和谐夫妇中的血清转换率。
在 928 名参与者中，有 755 名（81%）有 36 个月的数据：94 名（10%）死亡，79 名（9%）数据缺失。性活动从基线时的 28%增加到 41%[36 个月（P < 0.001）]。在有性行为的参与者中，22%的人在基线时报告了高危性行为，8%的人在 6 个月时报告了高危性行为（P < 0.001），14%的人在 36 个月时报告了高危性行为（P = 0.018）。报告高危性行为的参与者的中位病毒载量为 122500 拷贝/ml（四分位距[IQR] 45100-353000），在基线时未检出，随后在随访中未检出。62 对同居的血清不一致的伴侣中发生了 1 例血清转换（0.5 例血清转换/100 人年）。在 36 个月时，与血清不一致的伴侣的避孕套使用率为 74%，与血清未知的伴侣为 55%，与血清一致的伴侣为 46%。HIV 传播风险估计降低了 91%，从 47.3 降至 4.2/1000 人年。
尽管乌干达接受抗逆转录病毒治疗的艾滋病毒感染者在 3 年的时间里，性活动有所增加，但高危性行为和 HIV 传播的风险估计仍低于基线水平。综合预防方案可减少非洲的 HIV 传播。
