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. 2013 Aug 1;63(4):498-505.
doi: 10.1097/QAI.0b013e318293ae48.

Community viral load and CD4 count distribution among people living with HIV in a South African Township: implications for treatment as prevention

Katharina Kranzer  1 , Stephen D Lawn, Leigh F Johnson, Linda-Gail Bekker, Robin Wood
Affiliations

Community viral load and CD4 count distribution among people living with HIV in a South African Township: implications for treatment as prevention

Katharina Kranzer et al. J Acquir Immune Defic Syndr. .

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.

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Figures

Figure 1
Figure 1. Viral load distribution by self-reported treatment status
Proportions of individuals receiving ART are displayed in grey, Proportions of individuals not yet receiving ART are displayed in black.
See this image and copyright information in PMC

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