Effect of Universal Testing and Treatment on HIV Incidence - HPTN 071 (PopART)
Neural-Tube Defects and Antiretroviral Treatment Regimens in Botswana
Virological remission after antiretroviral therapy interruption in female African HIV seroconverters
Do people living with HIV experience greater age advancement than their HIV-negative counterparts?
Prednisone for the Prevention of Paradoxical Tuberculosis-Associated IRIS
Repeat testing of low-level HIV-1 RNA: assay performance and implementation in clinical trials
Enhanced Prophylaxis plus Antiretroviral Therapy for Advanced HIV Infection in Africa
Kidney Diseases Associated with Human Immunodeficiency Virus Infection
A Randomized, Controlled Trial of a Behavioral Weight Loss Program for HIV-Infected Patients
CD32a is a marker of a CD4 T-cell HIV reservoir harbouring replication-competent proviruses
Life expectancy in HIV-positive persons in Switzerland: matched comparison with general population
Successful Prevention of Transmission of Integrase Resistance in the Swiss HIV Cohort Study
Immunologic Biomarkers, Morbidity, and Mortality in Treated HIV Infection
Rosuvastatin slows progression of subclinical atherosclerosis in patients with treated HIV infection
Antiretroviral therapy for the prevention of HIV-1 transmission
HIV Transmission Risk Persists During the First 6 Months of Antiretroviral Therapy
Review of the Efficacy, Safety, and Pharmacokinetics of Raltegravir in Pregnancy
Use of Abacavir and Risk of Cardiovascular Disease Among HIV-Infected Individuals
Patterns of Cardiovascular Mortality for HIV-Infected Adults in the United States: 1999 to 2013
Adjunctive Dexamethasone in HIV-Associated Cryptococcal Meningitis
Outcomes of HIV-associated Hodgkin lymphoma in the era of antiretroviral therapy
CD8 T-Cell Expansion and Inflammation Linked to CMV Coinfection in ART-treated HIV Infection
Ongoing HIV Replication Replenishes Viral Reservoirs During Therapy
Incidence and progression of coronary artery calcium in HIV-infected and HIV-uninfected men
Levels of intracellular HIV-DNA in patients with suppressive antiretroviral therapy
Course and Clinical Significance of CD8+ T-Cell Counts in a Large Cohort of HIV-Infected Individuals
Impact of low-level viremia on clinical and virological outcomes in treated HIV-1-infected patients
Predicting the outcomes of treatment to eradicate the latent reservoir for HIV-1
Effect of Universal Testing and Treatment on HIV Incidence - HPTN 071 (PopART)
Published by Pedro CAHN
Updated: 6 November, 2019
BACKGROUND
A universal testing and treatment strategy is a potential approach to reduce the incidence of HIV infection, yet previous trial results are inconsistent.
METHODS
In the HPTN 071 (PopART) community-randomized trial conducted from 2013 through
2018, we randomly assigned 21 communities in Zambia and South Africa (total population, approximately 1 million) to group A (combination prevention intervention with universal ART), group B (the prevention intervention with ART provided according
to local guidelines [universal since 2016]), or group C (standard care). The prevention
intervention included home-based HIV testing delivered by community workers, who
also supported linkage to HIV care and ART adherence. The primary outcome, HIV incidence between months 12 and 36, was measured in a population cohort of approximately 2000 randomly sampled adults (18 to 44 years of age) per community. Viral suppression (<400 copies of HIV RNA per milliliter) was assessed in all HIV-positive participants at 24 months.
RESULTS
The population cohort included 48,301 participants. Baseline HIV prevalence was 21% or 22% in each group. Between months 12 and 36, a total of 553 new HIV infections were observed during 39,702 person-years (1.4 per 100 person-years; women, 1.7; men, 0.8). The adjusted rate ratio for group A as compared with group C was 0.93 (95% CI, 0.74 to 1.18; P = 0.51) and for group B as compared with group C was 0.70 (95% CI, 0.55 to 0.88; P = 0.006). The percentage of HIV-positive participants with viral suppression at 24 months was 71.9% in group A, 67.5% in group B, and 60.2% in group C. The estimated percentage of HIV-positive adults in the community who were receiving ART at 36 months was 81% in group A and 80% in group B.
CONCLUSIONS
A combination prevention intervention with ART provided according to local guidelines
resulted in a 30% lower incidence of HIV infection than standard care. The lack of effect
with universal ART was unanticipated and not consistent with the data on viral suppression. In this trial setting, universal testing and treatment reduced the population-level incidence of HIV infection.
