Findings suggest that quality of care required to reduce HIV transmissions can be achieved in resource-poor and remote settings
Selling blood brought in more money, quicker, than farmers across Henan province in China could earn any other way, but the practice came at an even higher price. By 1997 when the government cracked down on commercial blood collectors, who re-used tubing and other supplies as they extracted plasma and returned donors’ red blood cells, estimates of the numbers of people in the province who had been infected with HIV ranged from 50,000 to 170,000. Efforts to track transmission rates among married couples in which just one partner was infected began in 2006, and the resulting data gives a look at the real world prevention benefits of antiretroviral treatment, according to a study reported in Clinical Infectious Diseases.
The report, “Treatment to Prevent HIV Transmission in Serodiscordant Couples in Henan China 2006 to 2012,” discusses an analysis of data on nearly 5,000 couples — each with one infected and one uninfected partner at the start. None of the originally infected partners had ever received antiretroviral treatment when the first data was collected, but by the end of the six years tracked by the study more than 80 percent were receiving treatment. During those six years, 157 originally uninfected partners were diagnosed with HIV, with more than half of those transmissions occurring after the infected partner had begun to receive treatment, but more transmissions occurring within the first few years tracked than the latter three years. In addition, researchers noted higher rates of transmission from partners whose immune systems were more compromised, with immune cell, or CD4, counts less than 250 per cubic millimeter of blood.
The greater preventive benefit from antiretroviral treatment that evolved over time may have been helped by the improved — and easier to tolerate — antiretroviral drugs that became available during the period tracked, and treatment program improvements including more treatment adherence support. The authors conclude that adequate drugs, healthcare and adherence all boost the preventive benefit of treatment for HIV, and that the experience of Henan province indicates that all of those are possible in a resource poor and remote setting.
Authors of the report include M. Kumi Smith of the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, and Myron Cohen, who led the HPTN 052 study that proved the preventive value of early antiretroviral treatment in preventing transmission in couples with one infected partner.