Author(s): Kranzer K, Lawn SD, Johnson LF, Bekker LG, Wood R
Abstract Share this page
Abstract INTRODUCTION: The goals of scale-up of antiretroviral therapy (ART) have expanded from prevention of morbidity and death to include prevention of transmission. Morbidity and mortality risk are associated with CD4 count; transmission risk depends on plasma viral load (VL). This study aimed to describe CD4 count and VL distributions among HIV-infected individuals in a South African township to gain insights into the potential impact of ART scale-up on community HIV transmission risk. METHODS: A random sample of 10\% of the adult population was invited to attend an HIV testing service. Study procedures included a questionnaire, HIV testing, CD4 count, and VL testing. RESULTS: One thousand one hundred forty-four (88.0\%) of 1300 randomly selected individuals participated in the study. Two hundred sixty tested positive, giving an HIV prevalence of 22.7\% [95\% confidence interval (CI): 20.3 to 25.3]. A third of all HIV-infected individuals (33.5\%, 95\% CI: 27.8 to 39.6) reported taking ART. The median CD4 count was 417 cells per microliter (interquartile range, 285-627); 33 (12.7\%, 95\% CI: 8.9 to 17.4) had a CD4 count of ≤200 cells per microliter. VL measurements were available for 219 individuals (84.2\%) and were undetectable in 72 (33.9\%), >1500 copies per milliliter in 127 (58.0\%) and >10,000 copies per milliliter in 96 (43.8\%). Of those reporting they were receiving ART, 30.4\% had a VL >1500 copies per milliliter compared with 58.0\% of those reporting they were not receiving ART. CONCLUSIONS: A small proportion of those living with HIV in this community had a CD4 count of <200 cells per microliter; more than half had a VL high enough to be associated with considerable transmission risk. A substantial proportion of HIV-infected individuals remained at risk of transmitting HIV even after starting ART.
This article was published in J Acquir Immune Defic Syndr
and referenced in Journal of Clinical & Cellular Immunology