How far is reality of HIV treatment access from optimal? Study looks at preventive impact of antiretroviral therapy where waits are long, stockouts common, and status sometimes secret

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Preventive benefit still high, but lessened by access, disclosure obstacles in area where rates are among the highest on earth

In KwaZulu-Natal, where rates of HIV are the highest in South Africa, close to a third of adults live with HIV, and only a little more than a third of adults in their working years have paying work. The rate of people with access to treatment for HIV has grown in the last dozen years, but antiretroviral medicine stockouts are common, and staying in care is challenged. The success that is measured by suppression of the virus, an outcome of antiretroviral treatment that is consistent, monitored and effective, is less common there than in places with more resources.

clinicalinfectiousdiseases52016That’s where researchers went when they sought to examine the real-world impact of antiretroviral treatment on preventing HIV transmission from infected people to their uninfected partners in stable sexual relationships. Their goal, they recount in an article published with advance access in Clinical Infectious Diseases last week, was to compare the preventive impacts of treatment on the ground, when disclosure of HIV status also might be an issue, to the proven preventive impact of treatment found in research that includes the landmark HPTN 052 trial. At the Africa Centre for Population Health, they examined seven years of data culled from a surveillance program that included HIV testing, sexual histories, relationship status, and household demographic data. With data from more than 17,000 people between January 2005 and December 2013, they found that uninfected stable sexual partners of of HIV-infected people receiving antiretroviral treatment had 77 percent fewer HIV infections than uninfected partners of people not receiving treatment.

As clinical trials have shown, antiretroviral treatment was associated with a significant drop in new infections among uninfected partners of people living with HIV, researchers concluded. But with HPTN 052 having demonstrated that early and optimal access to treatment led to near elimination of transmission from infected to uninfected partners, the real world still falls far short of what is possible.

The study, Antiretroviral therapy to prevent HIV acquisition in serodiscordant couples in a hypendemic community in rural South Africa, was led by Catherine E. Oldenberg of the Harvard T.H. Chan School of Public Health’s Department of Epidemiology.

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