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Antiretroviral therapy to prevent HIV transmission in serodiscordant couples in China (2003-11): a national observational cohort study
作者: Jia, Zhongwei1,5; Mao, Yurong2; Zhang, Fujie2; Ruan, Yuhua2,3,4; Ma, Ye2; Li, Jian2; Guo, Wei2; Liu, Enwu2; Dou, Zhihui2; Zhao, Yan2; Wang, Lu2; Li, Qianqian6; Xie, Peiyan2,3,7; Tang, Houlin2; Han, Jing2; Jin, Xia2; Xu, Juan2; Xiong, Ran2; Zhao, Decai2; Li, Ping2,3,7; Wang, Xia2,3,4; Wang, Liyan1; Qing, Qianqian2; Ding, Zhengwei2; Chen, Ray Y.8; Liu, Zhongfu2; Shao, Yiming2,3,4
刊名: LANCET
发表日期: 2013-10-05
DOI: 10.1016/S0140-6736(12)61898-4
卷: 382, 期:9899, 页:1195-1203
收录类别: SCI
文章类型: Article
WOS标题词: Science & Technology
类目[WOS]: Medicine, General & Internal
研究领域[WOS]: General & Internal Medicine
关键词[WOS]: HUMAN-IMMUNODEFICIENCY-VIRUS ; HETEROSEXUAL TRANSMISSION ; INFECTED INDIVIDUALS ; SEXUAL TRANSMISSION ; DISCORDANT COUPLES ; DRUG-RESISTANCE ; VIRAL LOAD ; MORTALITY ; SEROCONVERSION ; METAANALYSIS
英文摘要:

Background On the basis of the results of the randomised clinical trial HPTN 052 and observational studies, WHO has recommended that antiretroviral therapy be off ered to all HIV-infected individuals with uninfected partners of the opposite sex (serodiscordant couples) to reduce the risk of transmission. Whether or not such a public health approach is feasible and the outcomes are sustainable at a large scale and in a developing country setting has not previously been assessed.

Methods In this retrospective observational cohort study, we included treated and treatment-naive HIV-positive individuals with HIV-negative partners of the opposite sex who had been added to the national HIV epidemiology and treatment databases between Jan 1, 2003 and Dec 31, 2011. We analysed the annual rate of HIV infection in HIVnegative partners during follow-up, stratifi ed by treatment status of the index partner. Cox proportional hazards analyses were done to examine factors related to HIV transmission.

Findings Based on data from 38 862 serodiscordant couples, with 101 295.1 person-years of follow-up for the seronegative partners, rates of HIV infection were 2.6 per 100 person-years (95% CI 2.4-2.8) among the 14 805 couples in the treatment-naive cohort (median baseline CD4 count for HIV-positive partners 441 cells per mu l [IQR 314-590]) and 1.3 per 100 person-years (1.2-1.3) among the 24 057 couples in the treated cohort (median baseline CD4 count for HIV-positive partners 168 cells per mu l [62-269]). We calculated a 26% relative reduction in HIV transmission (adjusted hazard ratio 0.74, 95% CI 0.65-0.84) in the treated cohort. The reduction in transmission was seen across almost all demographic subgroups and was signifi cant in the fi rst year (0.64, 0.54-0.76), and among couples in which the HIV-positive partner had been infected by blood or plasma transfusion (0.76, 0.59-0.99) or heterosexual intercourse (0.69, 0.56-0.84), but not among couples in which the HIV-positive partner was infected by injecting drugs (0.98, 0.71-1.36).

Interpretation Antiretroviral therapy for HIV-positive individuals in serodiscordant couples reduced HIV transmission across China, which suggests that the treatment-as-prevention approach is a feasible public health prevention strategy on a national scale in a developing country context. The durability and generalisability of such protection, however, needs to be further studied.

语种: 英语
项目资助者: Chinese Government&prime ; s 12th Five-Year Plan ; National Natural Science Foundation of China, ; Canadian International Development Research Centre
WOS记录号: WOS:000325209100024
Citation statistics:
内容类型: 期刊论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/51690
Appears in Collections:中国药物依赖性研究所_期刊论文

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作者单位: 1.Collaborat Innovat Ctr Infect Dis, Hangzhou, Zhejiang, Peoples R China
2.China Ocean Univ, Coll Math Sci, Qingdao, Peoples R China
3.Guangxi Med Univ, Sch Publ Hlth, Nanning, Peoples R China
4.Peking Univ, Natl Inst Drug Dependence, Beijing 100871, Peoples R China
5.Chinese Ctr Dis Control & Prevent, Natl Ctr AIDS STD Control & Prevent, Beijing 102206, Peoples R China
6.Chinese Ctr Dis Control & Prevent, State Key Lab Infect Dis Prevent & Control, Beijing 102206, Peoples R China
7.Harvard Univ, Sch Publ Hlth, Dept Global Hlth & Populat, Takemi Program Int Hlth, Boston, MA 02115 USA
8.NIAID, NIH, Bethesda, MD 20892 USA

Recommended Citation:
Jia, Zhongwei,Mao, Yurong,Zhang, Fujie,et al. Antiretroviral therapy to prevent HIV transmission in serodiscordant couples in China (2003-11): a national observational cohort study[J]. LANCET,2013,382(9899):1195-1203.
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