SEATTLE — Treatment as prevention strategy resulted
in significant reductions in HIV incidence in a sub-Saharan African setting
where the incidence for HIV acquisition is high, according to Frank Tanser,
MD.
Tanser and colleagues hypothesized that the rollout of
increased ART coverage would lead to a decreased risk for HIV within the
surrounding community of a rural hyper-endemic setting in sub-Saharan Africa.
“We wanted to see if we could use observational
data we collected to test the ‘treatment as prevention’ hypothesis in
a real-world sub-Saharan African setting,” he said. “This area has an
incredibly high rate for acquiring HIV infection. The lifetime risk of
acquiring HIV is 80% in females and 70% among males — this is incredibly
high. Since 2004, there has been a rapid rollout of ART and between 2004 and
2011 — about 20,000 individuals were initiated on treatment.”
Data were pooled on adults aged 15 years and older
included in the longitudinal HIV and demographic surveillance South Africa
program (n=10,000 people/year). The researchers compiled spatial variation
estimates in the proportion of HIV infected adults taking ART between 2004 and
2011.
A group of HIV-negative adults aged 15 years and older
(n=16,588) were also followed during the same time period. The effect of ART on
the surrounding local community was assessed on the risk for HIV.
Researchers observed a crude incidence rate in HIV
seroconversions of 2.63 per 100 person-years (95% CI, 2.5-2.77). In addition,
the researchers detected a 1.7% decrease in HIV acquisition faced by an
HIV-negative adult living in the surrounding community.
“These results clearly demonstrate that the rate of
new HIV infections can be reduced as a result of high coverage of ART and this
can be done in the real-world sub-Saharan African setting. This is the first
evidence recorded to date in this type of setting,” Tanser said.
For more information:
- Tanser F. #136LB. Presented at: the 19th Conference on Retroviruses and
Opportunistic Infections. March 5-8, 2012; Seattle.
Disclosures: The researchers report no relevant
financial disclosures.
To underscore the importance of rolling ART would have an impact beyond
just mortality and morbidity related to HIV infection.
– James Hakim, MD
University of Zimbabwe
College of Health Science