Using plasma viral load to guide antiretroviral therapy initiation to prevent HIV-1 transmission

Current WHO guidelines recommend antiretroviral therapy (ART) initiation at CD4 counts ≤350 cells/µL. Increasing this threshold has been proposed, with a primary goal of reducing HIV-1 infectiousness. Because the quantity of HIV-1 in plasma is the primary predictor of HIV-1 transmission, considerati...

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Veröffentlicht in:PloS one 2012-11, Vol.7 (11), p.e51192-e51192
Hauptverfasser: Murnane, Pamela M, Hughes, James P, Celum, Connie, Lingappa, Jairam R, Mugo, Nelly, Farquhar, Carey, Kiarie, James, Wald, Anna, Baeten, Jared M
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Sprache:eng
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Zusammenfassung:Current WHO guidelines recommend antiretroviral therapy (ART) initiation at CD4 counts ≤350 cells/µL. Increasing this threshold has been proposed, with a primary goal of reducing HIV-1 infectiousness. Because the quantity of HIV-1 in plasma is the primary predictor of HIV-1 transmission, consideration of plasma viral load in ART initiation guidelines is warranted. Using per-sex-act infectivity estimates and cross-sectional sexual behavior data from 2,484 HIV-1 infected persons with CD4 counts >350 enrolled in a study of African heterosexual HIV-1 serodiscordant couples, we calculated the number of transmissions expected and the number potentially averted under selected scenarios for ART initiation: i) CD4 count 350 while averting 40.5% of expected transmissions (ratio 2.0); treating at viral load ≥10,0000 copies/mL had a ratio of 1.5. In contrast, initiation at CD4 count
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0051192