Antiretroviral therapy to prevent HIV transmission in serodiscordant couples in China (2003–11): a national observational cohort study
Summary Background On the basis of the results of the randomised clinical trial HPTN 052 and observational studies, WHO has recommended that antiretroviral therapy be offered to all HIV-infected individuals with uninfected partners of the opposite sex (serodiscordant couples) to reduce the risk of t...
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| Veröffentlicht in: | The Lancet (British edition) 2013-10, Vol.382 (9899), p.1195-1203 |
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| creator | Jia, Zhongwei, PhD Mao, Yurong, PhD Zhang, Fujie, PhD Ruan, Yuhua, Prof Ma, Ye, PhD Li, Jian, PhD Guo, Wei, PhD Liu, Enwu, PhD Dou, Zhihui, MS Zhao, Yan, MD Wang, Lu, PhD Li, Qianqian Xie, Peiyan, BS Tang, Houlin, MS Han, Jing, MS Jin, Xia, MS Xu, Juan, PhD Xiong, Ran, MS Zhao, Decai, MS Li, Ping Wang, Xia, MPH Wang, Liyan, PhD Qing, Qianqian, MD Ding, Zhengwei, BS Chen, Ray Y, MD Liu, Zhongfu, Prof Shao, Yiming, Prof |
| description | Summary Background On the basis of the results of the randomised clinical trial HPTN 052 and observational studies, WHO has recommended that antiretroviral therapy be offered to all HIV-infected individuals with uninfected partners of the opposite sex (serodiscordant couples) to reduce the risk of transmission. Whether or not such a public health approach is feasible and the outcomes are sustainable at a large scale and in a developing country setting has not previously been assessed. Methods In this retrospective observational cohort study, we included treated and treatment-naive HIV-positive individuals with HIV-negative partners of the opposite sex who had been added to the national HIV epidemiology and treatment databases between Jan 1, 2003 and Dec 31, 2011. We analysed the annual rate of HIV infection in HIV-negative partners during follow-up, stratified by treatment status of the index partner. Cox proportional hazards analyses were done to examine factors related to HIV transmission. Findings Based on data from 38 862 serodiscordant couples, with 101 295·1 person-years of follow-up for the seronegative partners, rates of HIV infection were 2·6 per 100 person-years (95% CI 2·4–2·8) among the 14 805 couples in the treatment-naive cohort (median baseline CD4 count for HIV-positive partners 441 cells per μl [IQR 314–590]) and 1·3 per 100 person-years (1·2–1·3) among the 24 057 couples in the treated cohort (median baseline CD4 count for HIV-positive partners 168 cells per μl [62–269]). We calculated a 26% relative reduction in HIV transmission (adjusted hazard ratio 0·74, 95% CI 0·65–0·84) in the treated cohort. The reduction in transmission was seen across almost all demographic subgroups and was significant in the first year (0·64, 0·54–0·76), and among couples in which the HIV-positive partner had been infected by blood or plasma transfusion (0·76, 0·59–0·99) or heterosexual intercourse (0·69, 0·56–0·84), but not among couples in which the HIV-positive partner was infected by injecting drugs (0·98, 0·71–1·36). Interpretation Antiretroviral therapy for HIV-positive individuals in serodiscordant couples reduced HIV transmission across China, which suggests that the treatment-as-prevention approach is a feasible public health prevention strategy on a national scale in a developing country context. The durability and generalisability of such protection, however, needs to be further studied. Funding Chinese Government's 12th Five-Year Plan, the National |
| doi_str_mv | 10.1016/S0140-6736(12)61898-4 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1562666270</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0140673612618984</els_id><sourcerecordid>3091211761</sourcerecordid><originalsourceid>FETCH-LOGICAL-c601t-22f482a75102466c4b230c1965bc1419758eb1ee0ca9495bf4774ece6f6a597a3</originalsourceid><addsrcrecordid>eNqNks9u1DAQhyMEokvhEYBICGl7CIz_JxxA1QpopUocShE3y3Ec1iUbB9tZaW8cufOGPAnO7raVemlPluVvPs2Mf1n2HMEbBIi_PQdEoeCC8DnCRxyVVVnQB9kMUUELRsX3h9nsGjnInoRwCQCUA3ucHWCCgZeEzbI_x3203kTv1tarLo9L49WwyaPLB2_Wpo_5yem3PHrVh5UNwbo-t30ejHeNDdr5RiVEu3HoTJheFkvbq3yOAci_338ROnqXq7xXMRUmvatT5frqpt3S-ZiHODabp9mjVnXBPNufh9nFp49fFyfF2ZfPp4vjs0JzQLHAuKUlVoIhwJRzTWtMQKOKs1ojiirBSlMjY0CrilasbqkQ1GjDW65YJRQ5zOY77-Ddr9GEKNNY2nSd6o0bg0SMY845FnA3SlnJCKb3QlPXmIi09HughFTAGU_oq1vopRt92txEkUqUDMpJyHaU9i4Eb1o5eLtSfiMRyCkrcpsVOQVBIiy3WZE01b3Y28d6ZZrrqqtwJOD1HlBBq65NGdA23HBCMEGpSNzLHdcqJ9UPn5iLcwyIASACbDvIhx1h0s-urfEyaGt6bZqUPR1l4-ydzb6_ZdCd7W1q66fZmHCzFxmwhJ1kciC8NVDyH1y39-g</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1439785088</pqid></control><display><type>article</type><title>Antiretroviral therapy to prevent HIV transmission in serodiscordant couples in China (2003–11): a national observational cohort study</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Jia, Zhongwei, PhD ; Mao, Yurong, PhD ; Zhang, Fujie, PhD ; Ruan, Yuhua, Prof ; Ma, Ye, PhD ; Li, Jian, PhD ; Guo, Wei, PhD ; Liu, Enwu, PhD ; Dou, Zhihui, MS ; Zhao, Yan, MD ; Wang, Lu, PhD ; Li, Qianqian ; Xie, Peiyan, BS ; Tang, Houlin, MS ; Han, Jing, MS ; Jin, Xia, MS ; Xu, Juan, PhD ; Xiong, Ran, MS ; Zhao, Decai, MS ; Li, Ping ; Wang, Xia, MPH ; Wang, Liyan, PhD ; Qing, Qianqian, MD ; Ding, Zhengwei, BS ; Chen, Ray Y, MD ; Liu, Zhongfu, Prof ; Shao, Yiming, Prof</creator><creatorcontrib>Jia, Zhongwei, PhD ; Mao, Yurong, PhD ; Zhang, Fujie, PhD ; Ruan, Yuhua, Prof ; Ma, Ye, PhD ; Li, Jian, PhD ; Guo, Wei, PhD ; Liu, Enwu, PhD ; Dou, Zhihui, MS ; Zhao, Yan, MD ; Wang, Lu, PhD ; Li, Qianqian ; Xie, Peiyan, BS ; Tang, Houlin, MS ; Han, Jing, MS ; Jin, Xia, MS ; Xu, Juan, PhD ; Xiong, Ran, MS ; Zhao, Decai, MS ; Li, Ping ; Wang, Xia, MPH ; Wang, Liyan, PhD ; Qing, Qianqian, MD ; Ding, Zhengwei, BS ; Chen, Ray Y, MD ; Liu, Zhongfu, Prof ; Shao, Yiming, Prof</creatorcontrib><description>Summary Background On the basis of the results of the randomised clinical trial HPTN 052 and observational studies, WHO has recommended that antiretroviral therapy be offered to all HIV-infected individuals with uninfected partners of the opposite sex (serodiscordant couples) to reduce the risk of transmission. Whether or not such a public health approach is feasible and the outcomes are sustainable at a large scale and in a developing country setting has not previously been assessed. Methods In this retrospective observational cohort study, we included treated and treatment-naive HIV-positive individuals with HIV-negative partners of the opposite sex who had been added to the national HIV epidemiology and treatment databases between Jan 1, 2003 and Dec 31, 2011. We analysed the annual rate of HIV infection in HIV-negative partners during follow-up, stratified by treatment status of the index partner. Cox proportional hazards analyses were done to examine factors related to HIV transmission. Findings Based on data from 38 862 serodiscordant couples, with 101 295·1 person-years of follow-up for the seronegative partners, rates of HIV infection were 2·6 per 100 person-years (95% CI 2·4–2·8) among the 14 805 couples in the treatment-naive cohort (median baseline CD4 count for HIV-positive partners 441 cells per μl [IQR 314–590]) and 1·3 per 100 person-years (1·2–1·3) among the 24 057 couples in the treated cohort (median baseline CD4 count for HIV-positive partners 168 cells per μl [62–269]). We calculated a 26% relative reduction in HIV transmission (adjusted hazard ratio 0·74, 95% CI 0·65–0·84) in the treated cohort. The reduction in transmission was seen across almost all demographic subgroups and was significant in the first year (0·64, 0·54–0·76), and among couples in which the HIV-positive partner had been infected by blood or plasma transfusion (0·76, 0·59–0·99) or heterosexual intercourse (0·69, 0·56–0·84), but not among couples in which the HIV-positive partner was infected by injecting drugs (0·98, 0·71–1·36). Interpretation Antiretroviral therapy for HIV-positive individuals in serodiscordant couples reduced HIV transmission across China, which suggests that the treatment-as-prevention approach is a feasible public health prevention strategy on a national scale in a developing country context. The durability and generalisability of such protection, however, needs to be further studied. Funding Chinese Government's 12th Five-Year Plan, the National Natural Science Foundation of China, and the Canadian International Development Research Centre.</description><identifier>ISSN: 0140-6736</identifier><identifier>EISSN: 1474-547X</identifier><identifier>DOI: 10.1016/S0140-6736(12)61898-4</identifier><identifier>PMID: 23206835</identifier><identifier>CODEN: LANCAO</identifier><language>eng</language><publisher>Kidlington: Elsevier Ltd</publisher><subject>Acquired immune deficiency syndrome ; Adolescent ; Adult ; Aged ; AIDS ; Anti-HIV Agents - therapeutic use ; Antibiotics. Antiinfectious agents. Antiparasitic agents ; Antiretroviral agents ; Antiretroviral drugs ; Antiviral agents ; Biological and medical sciences ; blood plasma ; China - epidemiology ; cohort studies ; developing countries ; Disease transmission ; Drug therapy ; drugs ; durability ; Epidemiology ; Feasibility Studies ; Female ; General aspects ; Heterosexuality - statistics & numerical data ; HIV ; HIV infections ; HIV Infections - epidemiology ; HIV Infections - prevention & control ; HIV Seronegativity - drug effects ; Human immunodeficiency virus ; Human viral diseases ; Humans ; Incidence ; Infectious diseases ; Internal Medicine ; Male ; Medical sciences ; Middle Aged ; Observational studies ; Pharmacology. Drug treatments ; Prevention ; Public health ; randomized clinical trials ; research and development ; Retrospective Studies ; risk ; Sexual Partners ; Sexually transmitted diseases ; Socioeconomic Factors ; STD ; therapeutics ; Viral diseases ; Viral diseases of the lymphoid tissue and the blood. Aids ; World Health Organization ; Young Adult</subject><ispartof>The Lancet (British edition), 2013-10, Vol.382 (9899), p.1195-1203</ispartof><rights>Elsevier Ltd</rights><rights>2013 Elsevier Ltd</rights><rights>2014 INIST-CNRS</rights><rights>Copyright © 2013 Elsevier Ltd. All rights reserved.</rights><rights>Copyright Elsevier Limited Oct 5, 2013</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c601t-22f482a75102466c4b230c1965bc1419758eb1ee0ca9495bf4774ece6f6a597a3</citedby><cites>FETCH-LOGICAL-c601t-22f482a75102466c4b230c1965bc1419758eb1ee0ca9495bf4774ece6f6a597a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0140673612618984$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=27757447$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23206835$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jia, Zhongwei, PhD</creatorcontrib><creatorcontrib>Mao, Yurong, PhD</creatorcontrib><creatorcontrib>Zhang, Fujie, PhD</creatorcontrib><creatorcontrib>Ruan, Yuhua, Prof</creatorcontrib><creatorcontrib>Ma, Ye, PhD</creatorcontrib><creatorcontrib>Li, Jian, PhD</creatorcontrib><creatorcontrib>Guo, Wei, PhD</creatorcontrib><creatorcontrib>Liu, Enwu, PhD</creatorcontrib><creatorcontrib>Dou, Zhihui, MS</creatorcontrib><creatorcontrib>Zhao, Yan, MD</creatorcontrib><creatorcontrib>Wang, Lu, PhD</creatorcontrib><creatorcontrib>Li, Qianqian</creatorcontrib><creatorcontrib>Xie, Peiyan, BS</creatorcontrib><creatorcontrib>Tang, Houlin, MS</creatorcontrib><creatorcontrib>Han, Jing, MS</creatorcontrib><creatorcontrib>Jin, Xia, MS</creatorcontrib><creatorcontrib>Xu, Juan, PhD</creatorcontrib><creatorcontrib>Xiong, Ran, MS</creatorcontrib><creatorcontrib>Zhao, Decai, MS</creatorcontrib><creatorcontrib>Li, Ping</creatorcontrib><creatorcontrib>Wang, Xia, MPH</creatorcontrib><creatorcontrib>Wang, Liyan, PhD</creatorcontrib><creatorcontrib>Qing, Qianqian, MD</creatorcontrib><creatorcontrib>Ding, Zhengwei, BS</creatorcontrib><creatorcontrib>Chen, Ray Y, MD</creatorcontrib><creatorcontrib>Liu, Zhongfu, Prof</creatorcontrib><creatorcontrib>Shao, Yiming, Prof</creatorcontrib><title>Antiretroviral therapy to prevent HIV transmission in serodiscordant couples in China (2003–11): a national observational cohort study</title><title>The Lancet (British edition)</title><addtitle>Lancet</addtitle><description>Summary Background On the basis of the results of the randomised clinical trial HPTN 052 and observational studies, WHO has recommended that antiretroviral therapy be offered to all HIV-infected individuals with uninfected partners of the opposite sex (serodiscordant couples) to reduce the risk of transmission. Whether or not such a public health approach is feasible and the outcomes are sustainable at a large scale and in a developing country setting has not previously been assessed. Methods In this retrospective observational cohort study, we included treated and treatment-naive HIV-positive individuals with HIV-negative partners of the opposite sex who had been added to the national HIV epidemiology and treatment databases between Jan 1, 2003 and Dec 31, 2011. We analysed the annual rate of HIV infection in HIV-negative partners during follow-up, stratified by treatment status of the index partner. Cox proportional hazards analyses were done to examine factors related to HIV transmission. Findings Based on data from 38 862 serodiscordant couples, with 101 295·1 person-years of follow-up for the seronegative partners, rates of HIV infection were 2·6 per 100 person-years (95% CI 2·4–2·8) among the 14 805 couples in the treatment-naive cohort (median baseline CD4 count for HIV-positive partners 441 cells per μl [IQR 314–590]) and 1·3 per 100 person-years (1·2–1·3) among the 24 057 couples in the treated cohort (median baseline CD4 count for HIV-positive partners 168 cells per μl [62–269]). We calculated a 26% relative reduction in HIV transmission (adjusted hazard ratio 0·74, 95% CI 0·65–0·84) in the treated cohort. The reduction in transmission was seen across almost all demographic subgroups and was significant in the first year (0·64, 0·54–0·76), and among couples in which the HIV-positive partner had been infected by blood or plasma transfusion (0·76, 0·59–0·99) or heterosexual intercourse (0·69, 0·56–0·84), but not among couples in which the HIV-positive partner was infected by injecting drugs (0·98, 0·71–1·36). Interpretation Antiretroviral therapy for HIV-positive individuals in serodiscordant couples reduced HIV transmission across China, which suggests that the treatment-as-prevention approach is a feasible public health prevention strategy on a national scale in a developing country context. The durability and generalisability of such protection, however, needs to be further studied. Funding Chinese Government's 12th Five-Year Plan, the National Natural Science Foundation of China, and the Canadian International Development Research Centre.</description><subject>Acquired immune deficiency syndrome</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>AIDS</subject><subject>Anti-HIV Agents - therapeutic use</subject><subject>Antibiotics. Antiinfectious agents. Antiparasitic agents</subject><subject>Antiretroviral agents</subject><subject>Antiretroviral drugs</subject><subject>Antiviral agents</subject><subject>Biological and medical sciences</subject><subject>blood plasma</subject><subject>China - epidemiology</subject><subject>cohort studies</subject><subject>developing countries</subject><subject>Disease transmission</subject><subject>Drug therapy</subject><subject>drugs</subject><subject>durability</subject><subject>Epidemiology</subject><subject>Feasibility Studies</subject><subject>Female</subject><subject>General aspects</subject><subject>Heterosexuality - statistics & numerical data</subject><subject>HIV</subject><subject>HIV infections</subject><subject>HIV Infections - epidemiology</subject><subject>HIV Infections - prevention & control</subject><subject>HIV Seronegativity - drug effects</subject><subject>Human immunodeficiency virus</subject><subject>Human viral diseases</subject><subject>Humans</subject><subject>Incidence</subject><subject>Infectious diseases</subject><subject>Internal Medicine</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Observational studies</subject><subject>Pharmacology. Drug treatments</subject><subject>Prevention</subject><subject>Public health</subject><subject>randomized clinical trials</subject><subject>research and development</subject><subject>Retrospective Studies</subject><subject>risk</subject><subject>Sexual Partners</subject><subject>Sexually transmitted diseases</subject><subject>Socioeconomic Factors</subject><subject>STD</subject><subject>therapeutics</subject><subject>Viral diseases</subject><subject>Viral diseases of the lymphoid tissue and the blood. Aids</subject><subject>World Health Organization</subject><subject>Young Adult</subject><issn>0140-6736</issn><issn>1474-547X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BEC</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqNks9u1DAQhyMEokvhEYBICGl7CIz_JxxA1QpopUocShE3y3Ec1iUbB9tZaW8cufOGPAnO7raVemlPluVvPs2Mf1n2HMEbBIi_PQdEoeCC8DnCRxyVVVnQB9kMUUELRsX3h9nsGjnInoRwCQCUA3ucHWCCgZeEzbI_x3203kTv1tarLo9L49WwyaPLB2_Wpo_5yem3PHrVh5UNwbo-t30ejHeNDdr5RiVEu3HoTJheFkvbq3yOAci_338ROnqXq7xXMRUmvatT5frqpt3S-ZiHODabp9mjVnXBPNufh9nFp49fFyfF2ZfPp4vjs0JzQLHAuKUlVoIhwJRzTWtMQKOKs1ojiirBSlMjY0CrilasbqkQ1GjDW65YJRQ5zOY77-Ddr9GEKNNY2nSd6o0bg0SMY845FnA3SlnJCKb3QlPXmIi09HughFTAGU_oq1vopRt92txEkUqUDMpJyHaU9i4Eb1o5eLtSfiMRyCkrcpsVOQVBIiy3WZE01b3Y28d6ZZrrqqtwJOD1HlBBq65NGdA23HBCMEGpSNzLHdcqJ9UPn5iLcwyIASACbDvIhx1h0s-urfEyaGt6bZqUPR1l4-ydzb6_ZdCd7W1q66fZmHCzFxmwhJ1kciC8NVDyH1y39-g</recordid><startdate>20131005</startdate><enddate>20131005</enddate><creator>Jia, Zhongwei, PhD</creator><creator>Mao, Yurong, PhD</creator><creator>Zhang, Fujie, PhD</creator><creator>Ruan, Yuhua, Prof</creator><creator>Ma, Ye, PhD</creator><creator>Li, Jian, PhD</creator><creator>Guo, Wei, PhD</creator><creator>Liu, Enwu, PhD</creator><creator>Dou, Zhihui, MS</creator><creator>Zhao, Yan, MD</creator><creator>Wang, Lu, PhD</creator><creator>Li, Qianqian</creator><creator>Xie, Peiyan, BS</creator><creator>Tang, Houlin, MS</creator><creator>Han, Jing, MS</creator><creator>Jin, Xia, MS</creator><creator>Xu, Juan, PhD</creator><creator>Xiong, Ran, MS</creator><creator>Zhao, Decai, MS</creator><creator>Li, Ping</creator><creator>Wang, Xia, MPH</creator><creator>Wang, Liyan, PhD</creator><creator>Qing, Qianqian, MD</creator><creator>Ding, Zhengwei, BS</creator><creator>Chen, Ray Y, MD</creator><creator>Liu, Zhongfu, Prof</creator><creator>Shao, Yiming, Prof</creator><general>Elsevier Ltd</general><general>Elsevier</general><general>Elsevier Limited</general><scope>FBQ</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0TT</scope><scope>0TZ</scope><scope>0U~</scope><scope>3V.</scope><scope>7QL</scope><scope>7QP</scope><scope>7RV</scope><scope>7TK</scope><scope>7U7</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88A</scope><scope>88C</scope><scope>88E</scope><scope>88G</scope><scope>88I</scope><scope>8AF</scope><scope>8AO</scope><scope>8C1</scope><scope>8C2</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BEC</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K6X</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>KB~</scope><scope>LK8</scope><scope>M0R</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>M2P</scope><scope>M7N</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>S0X</scope><scope>7X8</scope><scope>7T2</scope><scope>7U1</scope><scope>7U2</scope><scope>7ST</scope><scope>7U6</scope></search><sort><creationdate>20131005</creationdate><title>Antiretroviral therapy to prevent HIV transmission in serodiscordant couples in China (2003–11): a national observational cohort study</title><author>Jia, Zhongwei, PhD ; Mao, Yurong, PhD ; Zhang, Fujie, PhD ; Ruan, Yuhua, Prof ; Ma, Ye, PhD ; Li, Jian, PhD ; Guo, Wei, PhD ; Liu, Enwu, PhD ; Dou, Zhihui, MS ; Zhao, Yan, MD ; Wang, Lu, PhD ; Li, Qianqian ; Xie, Peiyan, BS ; Tang, Houlin, MS ; Han, Jing, MS ; Jin, Xia, MS ; Xu, Juan, PhD ; Xiong, Ran, MS ; Zhao, Decai, MS ; Li, Ping ; Wang, Xia, MPH ; Wang, Liyan, PhD ; Qing, Qianqian, MD ; Ding, Zhengwei, BS ; Chen, Ray Y, MD ; Liu, Zhongfu, Prof ; Shao, Yiming, Prof</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c601t-22f482a75102466c4b230c1965bc1419758eb1ee0ca9495bf4774ece6f6a597a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Acquired immune deficiency syndrome</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>AIDS</topic><topic>Anti-HIV Agents - therapeutic use</topic><topic>Antibiotics. Antiinfectious agents. Antiparasitic agents</topic><topic>Antiretroviral agents</topic><topic>Antiretroviral drugs</topic><topic>Antiviral agents</topic><topic>Biological and medical sciences</topic><topic>blood plasma</topic><topic>China - epidemiology</topic><topic>cohort studies</topic><topic>developing countries</topic><topic>Disease transmission</topic><topic>Drug therapy</topic><topic>drugs</topic><topic>durability</topic><topic>Epidemiology</topic><topic>Feasibility Studies</topic><topic>Female</topic><topic>General aspects</topic><topic>Heterosexuality - statistics & numerical data</topic><topic>HIV</topic><topic>HIV infections</topic><topic>HIV Infections - epidemiology</topic><topic>HIV Infections - prevention & control</topic><topic>HIV Seronegativity - drug effects</topic><topic>Human immunodeficiency virus</topic><topic>Human viral diseases</topic><topic>Humans</topic><topic>Incidence</topic><topic>Infectious diseases</topic><topic>Internal Medicine</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Observational studies</topic><topic>Pharmacology. Drug treatments</topic><topic>Prevention</topic><topic>Public health</topic><topic>randomized clinical trials</topic><topic>research and development</topic><topic>Retrospective Studies</topic><topic>risk</topic><topic>Sexual Partners</topic><topic>Sexually transmitted diseases</topic><topic>Socioeconomic Factors</topic><topic>STD</topic><topic>therapeutics</topic><topic>Viral diseases</topic><topic>Viral diseases of the lymphoid tissue and the blood. Aids</topic><topic>World Health Organization</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jia, Zhongwei, PhD</creatorcontrib><creatorcontrib>Mao, Yurong, PhD</creatorcontrib><creatorcontrib>Zhang, Fujie, PhD</creatorcontrib><creatorcontrib>Ruan, Yuhua, Prof</creatorcontrib><creatorcontrib>Ma, Ye, PhD</creatorcontrib><creatorcontrib>Li, Jian, PhD</creatorcontrib><creatorcontrib>Guo, Wei, PhD</creatorcontrib><creatorcontrib>Liu, Enwu, PhD</creatorcontrib><creatorcontrib>Dou, Zhihui, MS</creatorcontrib><creatorcontrib>Zhao, Yan, MD</creatorcontrib><creatorcontrib>Wang, Lu, PhD</creatorcontrib><creatorcontrib>Li, Qianqian</creatorcontrib><creatorcontrib>Xie, Peiyan, BS</creatorcontrib><creatorcontrib>Tang, Houlin, MS</creatorcontrib><creatorcontrib>Han, Jing, MS</creatorcontrib><creatorcontrib>Jin, Xia, MS</creatorcontrib><creatorcontrib>Xu, Juan, PhD</creatorcontrib><creatorcontrib>Xiong, Ran, MS</creatorcontrib><creatorcontrib>Zhao, Decai, MS</creatorcontrib><creatorcontrib>Li, Ping</creatorcontrib><creatorcontrib>Wang, Xia, MPH</creatorcontrib><creatorcontrib>Wang, Liyan, PhD</creatorcontrib><creatorcontrib>Qing, Qianqian, MD</creatorcontrib><creatorcontrib>Ding, Zhengwei, BS</creatorcontrib><creatorcontrib>Chen, Ray Y, MD</creatorcontrib><creatorcontrib>Liu, Zhongfu, Prof</creatorcontrib><creatorcontrib>Shao, Yiming, Prof</creatorcontrib><collection>AGRIS</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>News PRO</collection><collection>Pharma and Biotech Premium PRO</collection><collection>Global News & ABI/Inform Professional</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts 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Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>British Nursing Index</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Newsstand Professional</collection><collection>ProQuest Biological Science Collection</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>ProQuest Psychology</collection><collection>Research Library</collection><collection>Science Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Risk Abstracts</collection><collection>Safety Science and Risk</collection><collection>Environment Abstracts</collection><collection>Sustainability Science Abstracts</collection><jtitle>The Lancet (British edition)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jia, Zhongwei, PhD</au><au>Mao, Yurong, PhD</au><au>Zhang, Fujie, PhD</au><au>Ruan, Yuhua, Prof</au><au>Ma, Ye, PhD</au><au>Li, Jian, PhD</au><au>Guo, Wei, PhD</au><au>Liu, Enwu, PhD</au><au>Dou, Zhihui, MS</au><au>Zhao, Yan, MD</au><au>Wang, Lu, PhD</au><au>Li, Qianqian</au><au>Xie, Peiyan, BS</au><au>Tang, Houlin, MS</au><au>Han, Jing, MS</au><au>Jin, Xia, MS</au><au>Xu, Juan, PhD</au><au>Xiong, Ran, MS</au><au>Zhao, Decai, MS</au><au>Li, Ping</au><au>Wang, Xia, MPH</au><au>Wang, Liyan, PhD</au><au>Qing, Qianqian, MD</au><au>Ding, Zhengwei, BS</au><au>Chen, Ray Y, MD</au><au>Liu, Zhongfu, Prof</au><au>Shao, Yiming, Prof</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Antiretroviral therapy to prevent HIV transmission in serodiscordant couples in China (2003–11): a national observational cohort study</atitle><jtitle>The Lancet (British edition)</jtitle><addtitle>Lancet</addtitle><date>2013-10-05</date><risdate>2013</risdate><volume>382</volume><issue>9899</issue><spage>1195</spage><epage>1203</epage><pages>1195-1203</pages><issn>0140-6736</issn><eissn>1474-547X</eissn><coden>LANCAO</coden><abstract>Summary Background On the basis of the results of the randomised clinical trial HPTN 052 and observational studies, WHO has recommended that antiretroviral therapy be offered to all HIV-infected individuals with uninfected partners of the opposite sex (serodiscordant couples) to reduce the risk of transmission. Whether or not such a public health approach is feasible and the outcomes are sustainable at a large scale and in a developing country setting has not previously been assessed. Methods In this retrospective observational cohort study, we included treated and treatment-naive HIV-positive individuals with HIV-negative partners of the opposite sex who had been added to the national HIV epidemiology and treatment databases between Jan 1, 2003 and Dec 31, 2011. We analysed the annual rate of HIV infection in HIV-negative partners during follow-up, stratified by treatment status of the index partner. Cox proportional hazards analyses were done to examine factors related to HIV transmission. Findings Based on data from 38 862 serodiscordant couples, with 101 295·1 person-years of follow-up for the seronegative partners, rates of HIV infection were 2·6 per 100 person-years (95% CI 2·4–2·8) among the 14 805 couples in the treatment-naive cohort (median baseline CD4 count for HIV-positive partners 441 cells per μl [IQR 314–590]) and 1·3 per 100 person-years (1·2–1·3) among the 24 057 couples in the treated cohort (median baseline CD4 count for HIV-positive partners 168 cells per μl [62–269]). We calculated a 26% relative reduction in HIV transmission (adjusted hazard ratio 0·74, 95% CI 0·65–0·84) in the treated cohort. The reduction in transmission was seen across almost all demographic subgroups and was significant in the first year (0·64, 0·54–0·76), and among couples in which the HIV-positive partner had been infected by blood or plasma transfusion (0·76, 0·59–0·99) or heterosexual intercourse (0·69, 0·56–0·84), but not among couples in which the HIV-positive partner was infected by injecting drugs (0·98, 0·71–1·36). Interpretation Antiretroviral therapy for HIV-positive individuals in serodiscordant couples reduced HIV transmission across China, which suggests that the treatment-as-prevention approach is a feasible public health prevention strategy on a national scale in a developing country context. The durability and generalisability of such protection, however, needs to be further studied. Funding Chinese Government's 12th Five-Year Plan, the National Natural Science Foundation of China, and the Canadian International Development Research Centre.</abstract><cop>Kidlington</cop><pub>Elsevier Ltd</pub><pmid>23206835</pmid><doi>10.1016/S0140-6736(12)61898-4</doi><tpages>9</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0140-6736 |
| ispartof | The Lancet (British edition), 2013-10, Vol.382 (9899), p.1195-1203 |
| issn | 0140-6736 1474-547X |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1562666270 |
| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Acquired immune deficiency syndrome Adolescent Adult Aged AIDS Anti-HIV Agents - therapeutic use Antibiotics. Antiinfectious agents. Antiparasitic agents Antiretroviral agents Antiretroviral drugs Antiviral agents Biological and medical sciences blood plasma China - epidemiology cohort studies developing countries Disease transmission Drug therapy drugs durability Epidemiology Feasibility Studies Female General aspects Heterosexuality - statistics & numerical data HIV HIV infections HIV Infections - epidemiology HIV Infections - prevention & control HIV Seronegativity - drug effects Human immunodeficiency virus Human viral diseases Humans Incidence Infectious diseases Internal Medicine Male Medical sciences Middle Aged Observational studies Pharmacology. Drug treatments Prevention Public health randomized clinical trials research and development Retrospective Studies risk Sexual Partners Sexually transmitted diseases Socioeconomic Factors STD therapeutics Viral diseases Viral diseases of the lymphoid tissue and the blood. Aids World Health Organization Young Adult |
| title | Antiretroviral therapy to prevent HIV transmission in serodiscordant couples in China (2003–11): a national observational cohort study |
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