June 10, 2016
2 min read

ART reduces HIV in rural South African serodiscordant couples

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

Data from a study published in Clinical Infectious Diseases demonstrate ART was effective in preventing HIV transmission among serodiscordant couples in Sub-Saharan Africa.

The treatment effect, however, was not as high as the near-complete transmission elimination demonstrated in the HPTN-052 trial. The researchers recommended the use of ART in these hyperendemic regions, but suggested additional measures may be warranted to prevent the spread of the virus.

Previous trials have reported success in preventing HIV transmission with ART, such as the HPTN-052 study, in which ART nearly eliminated HIV transmission between couples. Until recently, however, there was scant evidence that those results would translate into success for regions where HIV patients often fail to disclose their status to their sexual partners, and where ART receipt may be inconsistent.

“Evidence of the efficacy of ART has primarily arisen from randomized trials or cohorts of serodiscordant couples who volunteered to participate in a clinical study by enrolling in serodiscordant couple clinics or partner testing programs,” Catherine E. Oldenburg, ScD, MPH, of the department of epidemiology at Harvard T.H. Chan School of Public Health, and colleagues wrote. “These studies were highly controlled and resource-rich and thus do not represent the real-life settings of the resource-poor public-sector health systems in the hyperendemic communities of [Sub-Saharan Africa (SSA)].”

In a population-based open cohort study, Oldenburg and colleagues compiled data from individuals in stable serodiscordant relationships (n = 17,016) in rural South Africa between January 2005 and December 2013. Participants came from the community of KwaZulu-Natal which, with an adult infection rate of 29%, has the highest incidence of HIV in the country, according to the researchers.

Of the individuals who participated in the study, 2,029 had a cohabiting partner. Of those, 196 lived with a partner infected with HIV, and 1,846 lived with an HIV-uninfected partner. The participants were tested for disease between two and nine times. Couples in which the HIV-infected partner used ART had a 77% reduction in HIV acquisition (adjusted HR = 0.23; 95% CI, 0.07-0.8) — a “very large” reduction, the researchers wrote, but still less effective than ART used in the HPTN-052 trial.

“While the HIV prevention effect in this ‘real life’ study is large, it falls short of the near-complete elimination of HIV transmission observed in the HPTN-052 study, suggesting that additional prevention interventions will likely be required to eliminate HIV transmission in serodiscordant couples in SSA,” the researchers wrote. – by Andy Polhamus

Disclosure: The researchers report no relevant financial disclosures.