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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

Rosuvastatin Is Effective to Decrease CD8 T-Cell Activation Only in HIV-Infected Patients With High Residual T-Cell Activation Under Antiretroviral Therapy

Botswana's progress toward achieving the 2020 UNAIDS 90-90-90 antiretroviral therapy and virological suppression goals: a population-based survey

Empirical tuberculosis therapy versus isoniazid in adult outpatients with advanced HIV initiating antiretroviral therapy (REMEMBER): a multicountry open-label randomised controlled trial

Feasibility and efficacy of early lung cancer diagnosis with chest computed tomography in HIV-infected smokers

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

CD4+ and CD8+ T-cell kinetics in aviremic HIV-infected patients developing Hodgkin or non-Hodgkin lymphoma

CD8 T-Cell Expansion and Inflammation Linked to CMV Coinfection in ART-treated HIV Infection

Human Immunodeficiency Virus Infection Does Not Worsen Prognosis of Liver Transplantation for Hepatocellular Carcinoma

Ongoing HIV Replication Replenishes Viral Reservoirs During Therapy

Incidence and progression of coronary artery calcium in HIV-infected and HIV-uninfected men

Transient elastography for the detection of hepatic fibrosis in HIV-monoinfected adults with elevated aminotransferases on antiretroviral therapy

Association of immune-activation and senescence markers with non-AIDS-defining comorbidities in HIV-suppressed patients

Effects of randomized rosuvastatin compared with placebo on bone and body composition among HIV-infected adults

Levels of intracellular HIV-DNA in patients with suppressive antiretroviral therapy

Cancer Risk and Use of Protease Inhibitor or Nonnucleoside Reverse Transcriptase Inhibitor–Based Combination Antiretroviral Therapy The D:A:D Study

Time trends for risk of severe age-related diseases in individuals with and without HIV infection in Denmark: a nationwide population-based cohort study

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The effect of cumulating exposure to abacavir on the risk of cardiovascular disease events in patients from the Swiss HIV Cohort Study

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

HIV-1 subtype B-infected MSM may have driven the spread of transmitted resistant strains in France in 2007-12: impact on susceptibility to first-line strategies

Influence of the Timing of Antiretroviral Therapy on the Potential for Normalization of Immune Status in Human Immunodeficiency Virus 1–Infected Individuals

Cross-sectional Comparison of the Prevalence of Age-Associated Comorbidities and Their Risk Factors Between HIV-Infected and Uninfected Individuals: The AGEhIV Cohort Study

CD4/CD8 ratio normalisation and non-AIDS-related events in individuals with HIV who achieve viral load suppression with antiretroviral therapy: an observational cohort study

Baseline HIV-1 resistance, virological outcomes, and emergent resistance in the SECOND-LINE trial: an exploratory analysis

Effects of statin therapy on coronary artery plaque volume and high-risk plaque morphology in HIV-infected patients with subclinical atherosclerosis: a randomised, double-blind, placebo-controlled trial

Low Bone Mineral Density in Patients With Well-Suppressed HIV Infection: Association With Body Weight, Smoking, and Prior Advanced HIV Disease

Early versus delayed initiation of highly active antiretroviral therapy for HIV-positive adults with newly diagnosed pulmonary tuberculosis (TB-HAART): a prospective, international, randomised, placebo-controlled trial

A chronic kidney disease risk score to determine tenofovir safety in a prospective cohort of HIV-positive male veterans

Single-agent tenofovir versus combination emtricitabine plus tenofovir for pre-exposure prophylaxis for HIV-1 acquisition: an update of data from a randomised, double-blind, phase 3 trial

Predicting the outcomes of treatment to eradicate the latent reservoir for HIV-1

HIV Transmission Risk Persists During the First 6 Months of Antiretroviral Therapy
Published by Anton POZNAK

Updated: 15 October, 2016

Mujugira A et al. J Acquir Immune Defic Syndr. 2016 Aug 15;72(5):579-84

Objective:
Combination antiretroviral therapy (ART) decreases the risk of sexual HIV transmission by suppressing blood and genital HIV RNA concentrations. However, HIV transmission risk may persist prior to achieving complete viral suppression.

Methods:
The Partners PrEP Study is a prospective cohort study of 4747 heterosexual HIV-serodiscordant couples in Kenya and Uganda, where couples were sexually active and planning to remain as a couple for the duration of the study. HIV-infected partners were not eligible for ART according to national guidelines at the time of enrollment. During follow-up, they received regular clinical and immunological monitoring and referrals for ART if they became eligible for treatment, initially at CD4 <200 cells/μL (Kenya) and <250 cells/μL (Uganda), which was revised to ≤350 cells/μL in both countries while the study was ongoing. ART use by HIV-infected partners and sexual behavior as reported by both members of the couple were assessed every three months. All participants received a package of HIV prevention services including individual and couple risk-reduction counseling, free condoms, and screening and treatment of sexually transmitted infections. At all study sites, HIV-uninfected women were provided with contraception counseling and free contraceptives.

Multiple markers of HIV transmission risk during the first months after ART initiation were examined: time to viral suppression in blood, persistence of HIV RNA in genital specimens, sexual risk behavior, pregnancy incidence, and HIV transmission using survival analysis and GEE logistic regression. At enrollment, every six months and at study exit, blood was collected from HIV-infected partners for HIV RNA quantification. Cervical specimens were collected at enrollment, annually and study exit. Semen collection was scheduled at the six and twelve month visits.

HIV serological testing for HIV-uninfected partners was performed monthly. Linkage between HIV seroconverters and their study partners was ascertained using HIV pol gene consensus sequencing. Follow-up time was computed beginning on the date of the study visit at which ART use was first reported (thus, after ART had started).

Results:
Of the 2184 HIV-infected persons eligible for ART in the Partners PrEP Study,1817 (83%) initiated ART (1062 women and 755 men), of which 1592 were followed for 474 person-years to assess time to first viral suppression. The cumulative probabilities of achieving blood viral suppression (<80 copies/ml) 3, 6 and 9-months after ART initiation were 65.3%, 84.8% and 89.1%, respectively. Endocervical and seminal HIV RNA were detectable in 12% and 21% of samples obtained within 6-months of ART. Among 454 swabs collected when blood HIV RNA concentrations were undetectable (<40 copies/mL), endocervical HIV RNA was detected in 8% (36 swabs from 36 women), and the median quantity was 3.14 log 10 copies/swab (IQR, 2.88-3.53). When blood HIV RNA concentrations were detectable, endocervical HIV RNA was detected in 23% (39/171) of swabs. Among 132 semen samples collected after blood HIV RNA concentrations were suppressed, 9% (12 samples from 10 men) had detectable seminal HIV RNA and the median quantity detected was 2.60 log 10 copies/mL. When blood HIV RNA concentrations were detectable, seminal HIV RNA was detected in 42% (30/72) of swabs. Pregnancy incidence was 8.8 per 100 person-years during the first 6-months of ART, and sex unprotected by condoms was reported at 10.5% of visits. Among initially uninfected partners, HIV incidence before ART was 2.08 per 100 person-years (55 infections; 2644 person-years), 1.79 for 0-6 months after ART initiation (3 infections; 168 person-years), and 0.00 (95% CI: 0,00-2,00) with >6 months of ART (0 infections; 167 person-years). All three ART-exposed HIV events were phylogenetically-linked female-to-male transmissions and occurred prior to complete viral suppression in blood and genital secretions.