Based on results of randomised clinical trials the World Health Organization recommends antiretroviral drugs for all HIV infected adults in serodiscordant heterosexual relationships at all stages of the disease. But does this strategy work in real life situations?
A recent study published in the Lancet has for the first time reported that such a public health approach is feasible and the outcomes are sustainable at a large scale and in a developing country setting.
New analyses from China look encouraging, say researchers. Between 2003 and 2011, uninfected partners of treated people were significantly less likely to seroconvert than uninfected partners of untreated people (1.3 infections/100 person years (95% CI 1.2 to 1.3) v 2.6 (2.4 to 2.8)). After adjustments, treatment of infected partners was associated with a 26% reduction in risk of transmission to uninfected partners (hazard ratio 0.74, 0.65 to 0.84).
The analyses compared around 24 000 treated couples with nearly 15 000 untreated couples registered in China’s national HIV epidemiology database.
It is hard to say whether treatment was entirely responsible for reducing transmission, because people who were treated were older, sicker, and may have had less sex, or less risky sex, than those who were not yet treated, says a linked comment by the Lancet
But the findings hint at a direct effect. Treated couples looked better protected, despite the relatively low CD4 counts (and presumably higher viral loads) necessary for treatment in China.
Treatment was associated with lower transmission when HIV had been acquired from a transfusion of blood products (50% of the treated couples) or heterosexual sex, but not when it had been acquired from injecting drugs.