Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
J Acquir Immune Defic Syndr. 2013 Aug 1;63(4):498-505. doi: 10.1097/QAI.0b013e318293ae48.
The goals of scale-up of antiretroviral therapy (ART) have expanded from prevention of morbidity and death to include prevention of transmission. Morbidity and mortality risk are associated with CD4 count; transmission risk depends on plasma viral load (VL). This study aimed to describe CD4 count and VL distributions among HIV-infected individuals in a South African township to gain insights into the potential impact of ART scale-up on community HIV transmission risk.
A random sample of 10% of the adult population was invited to attend an HIV testing service. Study procedures included a questionnaire, HIV testing, CD4 count, and VL testing.
One thousand one hundred forty-four (88.0%) of 1300 randomly selected individuals participated in the study. Two hundred sixty tested positive, giving an HIV prevalence of 22.7% [95% confidence interval (CI): 20.3 to 25.3]. A third of all HIV-infected individuals (33.5%, 95% CI: 27.8 to 39.6) reported taking ART. The median CD4 count was 417 cells per microliter (interquartile range, 285-627); 33 (12.7%, 95% CI: 8.9 to 17.4) had a CD4 count of ≤200 cells per microliter. VL measurements were available for 219 individuals (84.2%) and were undetectable in 72 (33.9%), >1500 copies per milliliter in 127 (58.0%) and >10,000 copies per milliliter in 96 (43.8%). Of those reporting they were receiving ART, 30.4% had a VL >1500 copies per milliliter compared with 58.0% of those reporting they were not receiving ART.
A small proportion of those living with HIV in this community had a CD4 count of <200 cells per microliter; more than half had a VL high enough to be associated with considerable transmission risk. A substantial proportion of HIV-infected individuals remained at risk of transmitting HIV even after starting ART.
抗逆转录病毒疗法（ART）扩展的目标已从预防发病和死亡扩展到预防传播。发病率和死亡率与 CD4 计数有关；传播风险取决于血浆病毒载量（VL）。本研究旨在描述南非一个乡镇中感染 HIV 的个体的 CD4 计数和 VL 分布情况，以深入了解 ART 扩展对社区 HIV 传播风险的潜在影响。
邀请 10%的成年人口参加 HIV 检测服务。研究程序包括问卷调查、HIV 检测、CD4 计数和 VL 检测。
在随机选择的 1300 人中，有 1144 人（88.0%）参加了研究。260 人检测呈阳性，HIV 感染率为 22.7%（95%置信区间：20.3%至 25.3%）。三分之一（33.5%，95%置信区间：27.8%至 39.6%）的所有 HIV 感染者报告正在接受 ART。中位数 CD4 计数为 417 个细胞/微升（四分位间距：285-627）；33 人（12.7%，95%置信区间：8.9%至 17.4%）的 CD4 计数≤200 个细胞/微升。有 219 人（84.2%）提供了 VL 测量值，其中 72 人（33.9%）不可检测，127 人（58.0%）>1500 拷贝/毫升，96 人（43.8%）>10000 拷贝/毫升。报告正在接受 ART 的人中，有 30.4%的 VL>1500 拷贝/毫升，而报告未接受 ART 的人中，有 58.0%的 VL>1500 拷贝/毫升。
在这个社区中，只有一小部分 HIV 感染者的 CD4 计数<200 个细胞/微升；超过一半的人 VL 高到足以带来相当大的传播风险。即使在开始接受 ART 后，仍有相当一部分 HIV 感染者仍有传播 HIV 的风险。
