Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Aug 15;72(5):579-84.
doi: 10.1097/QAI.0000000000001019.

HIV Transmission Risk Persists During the First 6 Months of Antiretroviral Therapy

Andrew Mujugira  1 , Connie Celum, Robert W Coombs, James D Campbell, Patrick Ndase, Allan Ronald, Edwin Were, Elizabeth A Bukusi, Nelly Mugo, James Kiarie, Jared M Baeten; Partners PrEP Study Team
Affiliations

HIV Transmission Risk Persists During the First 6 Months of Antiretroviral Therapy

Andrew Mujugira et al. J Acquir Immune Defic Syndr. .

Abstract

Objective: Combination antiretroviral therapy (ART) decreases the risk of sexual HIV transmission by suppressing blood and genital HIV RNA concentrations. We sought to determine HIV transmission risk prior to achieving complete viral suppression.

Design: Prospective cohort study.

Methods: Using data from the Partners PrEP Study, a prospective study of 4747 heterosexual HIV-serodiscordant couples in Kenya and Uganda, we examined multiple markers of HIV transmission risk during the first months after ART initiation: time to viral suppression in blood, persistence of HIV RNA in genital specimens, sexual risk behavior, pregnancy incidence, and HIV transmission using survival analysis and generalized estimating equations logistic regression.

Results: The cumulative probabilities of achieving blood viral suppression (<80 copies per milliliter) 3, 6, and 9 months after ART initiation were 65.3%, 84.8%, and 89.1%, respectively. Endocervical and seminal HIV RNA were detectable in 12% and 21% of samples obtained within 6 months of ART. Pregnancy incidence was 8.8 per 100 person-years during the first 6 months of ART, and sex unprotected by condoms was reported at 10.5% of visits. Among initially uninfected partners, HIV incidence before ART was 2.08 per 100 person-years (55 infections; 2644 person-years), 1.79 for 0-6 months after ART initiation (3 infections; 168 person-years), and 0.00 with >6 months of ART (0 infections; 167 person-years).

Conclusions: Residual HIV transmission risk persists during the first 6 months of ART, with incomplete viral suppression in blood and genital compartments. For HIV-serodiscordant couples in which the infected partner starts ART, other prevention options are needed, such as pre-exposure prophylaxis, until viral suppression is achieved.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
Cumulative probability of blood viral suppression from date of first visit at which ART use was reported
See this image and copyright information in PMC

References

    1. Quinn TC, Wawer MJ, Sewankambo N, et al. Viral load and heterosexual transmission of human immunodeficiency virus type 1. Rakai Project Study Group. N Engl J Med. 2000;342(13):921–929. - PubMed
    1. Baeten JM, Kahle E, Lingappa JR, et al. Genital HIV RNA predicts risk of heterosexual HIV transmission. Sci Transl Med. 2011;3(77):77ra29. - PMC - PubMed
    1. Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505. - PMC - PubMed
    1. Perelson AS, Essunger P, Cao Y, et al. Decay characteristics of HIV-infected compartments during combination therapy. Nature. 1997;387(6629):188–191. - PubMed
    1. Hilldorfer BB, Cillo AR, Besson GJ, Bedison MA, Mellors JW. New tools for quantifying HIV reservoirs: blood RNA single copy assays and beyond. Curr HIV/AIDS Rep. 2012;9(1):91–100. - PMC - PubMed

Publication types

MeSH terms