Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China.
PLoS One. 2013 Nov 13;8(11):e77981. doi: 10.1371/journal.pone.0077981. eCollection 2013.
Although HIV treatment as prevention (TasP) via early antiretroviral therapy (ART) has proven to reduce transmissions among HIV-serodiscordant couples, its full implementation in developing countries remains a challenge. In this study, we determine whether China's current HIV treatment program prevents new HIV infections among discordant couples in rural China.
A prospective, longitudinal cohort study was conducted from June 2009 to March 2011, in rural Yunnan. A total of 1,618 HIV-discordant couples were eligible, 1,101 were enrolled, and 813 were followed for an average of 1.4 person-years (PY). Routine ART was prescribed to HIV-positive spouses according to eligibility (CD4<350 cells/µl). Seroconversion was used to determine HIV incidence.
A total of 17 seroconversions were documented within 1,127 PY of follow-up, for an overall incidence of 1.5 per 100 PY. Epidemiological and genetic evidence confirmed that all 17 seroconverters were infected via marital secondary sexual transmission. Having an ART-experienced HIV-positive partner was associated with a lower rate of seroconvertion compared with having an ART-naïve HIV-positive partner (0.8 per 100 PY vs. 2.4 per 100 PY, HR = 0.34, 95%CI = 0.12-0.97, p = 0.0436). While we found that ART successfully suppressed plasma viral load to <400 copies/ml in the majority of cases (85.0% vs. 19.5%, p<0.0001 at baseline), we did document five seroconversions among ART-experienced subgroup.
ART is associated with a 66% reduction in HIV incidence among discordant couples in our sample, demonstrating the effectiveness of China's HIV treatment program at preventing new infections, and providing support for earlier ART initiation and TasP implementation in this region.
尽管通过早期抗逆转录病毒疗法（ART）进行艾滋病毒治疗即预防（TasP）已被证明可降低艾滋病毒血清学不一致的夫妇之间的传播，但在发展中国家全面实施这一措施仍然是一个挑战。在这项研究中，我们确定中国目前的艾滋病毒治疗方案是否能预防中国农村艾滋病毒血清学不一致的夫妇中新的艾滋病毒感染。
这是一项从 2009 年 6 月至 2011 年 3 月在云南省农村地区进行的前瞻性、纵向队列研究。共有 1618 对艾滋病毒血清学不一致的夫妇符合条件，其中 1101 对夫妇入组，813 对夫妇平均随访 1.4 人年（PY）。根据资格（CD4<350 个细胞/µl）为艾滋病毒阳性配偶开处方常规 ART。血清转换用于确定艾滋病毒的发病率。
在 1127 人年的随访中，共记录了 17 例血清转换，总发病率为每 100PY1.5 例。流行病学和遗传证据证实，所有 17 例血清转换者均通过婚姻二次性传播感染。与艾滋病毒阳性伴侣未接受 ART 治疗相比，艾滋病毒阳性伴侣接受过 ART 治疗的患者血清转换率较低（每 100PY0.8 例 vs. 每 100PY2.4 例，HR=0.34，95%CI=0.12-0.97，p=0.0436）。虽然我们发现大多数情况下（基线时分别为 85.0%和 19.5%，p<0.0001）ART 成功将血浆病毒载量抑制到<400 拷贝/ml，但我们确实在接受过 ART 的亚组中记录了 5 例血清转换。
ART 使我们样本中艾滋病毒血清学不一致的夫妇中的 HIV 发病率降低了 66%，证明了中国艾滋病毒治疗方案在预防新感染方面的有效性，并为该地区更早地启动 ART 和实施 TasP 提供了支持。
