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Reduction in HIV community viral loads following the implementation of a “Treatment as Prevention” strategy over 2 years at a population-level among men who have sex with men in Hangzhou, China

BACKGROUND: Previous studies have shown that the increased coverage of antiretroviral therapy (ART) could reduce the community viral load (CVL) and reduce the occurrence of new HIV infections. However, the impact on the reduction of HIV transmission among men who have sex with men (MSM) is much less...

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Autores principales: He, Lin, Yang, Jiezhe, Ma, Qiaoqin, Zhang, Jiafeng, Xu, Yun, Xia, Yan, Chen, Wanjun, Wang, Hui, Zheng, Jinlei, Jiang, Jun, Luo, Yan, Xu, Ke, Zhang, Xingliang, Xia, Shichang, Pan, Xiaohong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5796494/
https://www.ncbi.nlm.nih.gov/pubmed/29390979
http://dx.doi.org/10.1186/s12879-017-2927-2
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author He, Lin
Yang, Jiezhe
Ma, Qiaoqin
Zhang, Jiafeng
Xu, Yun
Xia, Yan
Chen, Wanjun
Wang, Hui
Zheng, Jinlei
Jiang, Jun
Luo, Yan
Xu, Ke
Zhang, Xingliang
Xia, Shichang
Pan, Xiaohong
author_facet He, Lin
Yang, Jiezhe
Ma, Qiaoqin
Zhang, Jiafeng
Xu, Yun
Xia, Yan
Chen, Wanjun
Wang, Hui
Zheng, Jinlei
Jiang, Jun
Luo, Yan
Xu, Ke
Zhang, Xingliang
Xia, Shichang
Pan, Xiaohong
author_sort He, Lin
collection PubMed
description BACKGROUND: Previous studies have shown that the increased coverage of antiretroviral therapy (ART) could reduce the community viral load (CVL) and reduce the occurrence of new HIV infections. However, the impact on the reduction of HIV transmission among men who have sex with men (MSM) is much less certain. The frequency of HIV infections in MSM have been rapidly increasing in recent years in Hangzhou, China. The “Treatment as Prevention” strategy was implemented at a population-level for HIV-infected MSM from January 2014 to June 2016 in Hangzhou; it aimed to increase the ART coverage, reduce the CVL, and reduce HIV transmission. METHODS: We investigated a subset of MSM diagnosed with HIV pre- and post-implementation of the strategy, using random sampling methods. Viral load (VL) testing was performed for all enrolled individuals; the lower limits of detection were 20 and 50 copies/mL. The data on infections were collected from the national epidemiology database of Hangzhou. Logistic regression analyses were conducted to identify factors associated with the differences in social demographic characteristics and available VL data. RESULTS: The ART coverage increased from 60.7% (839/1383) during the pre-implementation period to 92.3% (2183/2365) during the post-implementation period in Hangzhou. A total of 940 HIV-infected MSM were selected for inclusion in this study: 490 (52.1%) and 450 (47.9%) MSM in the pre- and post-implementation periods, respectively. In total, 89.5% (841/940) of patients had data available on VL rates. The mean CVL was 579 copies/mL pre-implementation and this decreased to 33 copies/mL post-implementation (Kruskal-Wallis < 0.001). The mean CVL decreased for all variables investigated post-implementation of the treatment strategy (P < 0.05). The undetectable VL (≤400 copies/mL) rate pre-implementation period was 50.0% which increased to 84.7% post-implementation (P < 0.001). The mean CVL at the county level significantly decreased in each county post-implementation (Kruskal-Wallis < 0.05). CONCLUSION: Our study confirmed a population-level association between increased ART coverage and decreased mean CVL; overall 84.7% of HIV infected MSM had an undetectable VL and were no longer infectious.
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spelling pubmed-57964942018-02-12 Reduction in HIV community viral loads following the implementation of a “Treatment as Prevention” strategy over 2 years at a population-level among men who have sex with men in Hangzhou, China He, Lin Yang, Jiezhe Ma, Qiaoqin Zhang, Jiafeng Xu, Yun Xia, Yan Chen, Wanjun Wang, Hui Zheng, Jinlei Jiang, Jun Luo, Yan Xu, Ke Zhang, Xingliang Xia, Shichang Pan, Xiaohong BMC Infect Dis Research Article BACKGROUND: Previous studies have shown that the increased coverage of antiretroviral therapy (ART) could reduce the community viral load (CVL) and reduce the occurrence of new HIV infections. However, the impact on the reduction of HIV transmission among men who have sex with men (MSM) is much less certain. The frequency of HIV infections in MSM have been rapidly increasing in recent years in Hangzhou, China. The “Treatment as Prevention” strategy was implemented at a population-level for HIV-infected MSM from January 2014 to June 2016 in Hangzhou; it aimed to increase the ART coverage, reduce the CVL, and reduce HIV transmission. METHODS: We investigated a subset of MSM diagnosed with HIV pre- and post-implementation of the strategy, using random sampling methods. Viral load (VL) testing was performed for all enrolled individuals; the lower limits of detection were 20 and 50 copies/mL. The data on infections were collected from the national epidemiology database of Hangzhou. Logistic regression analyses were conducted to identify factors associated with the differences in social demographic characteristics and available VL data. RESULTS: The ART coverage increased from 60.7% (839/1383) during the pre-implementation period to 92.3% (2183/2365) during the post-implementation period in Hangzhou. A total of 940 HIV-infected MSM were selected for inclusion in this study: 490 (52.1%) and 450 (47.9%) MSM in the pre- and post-implementation periods, respectively. In total, 89.5% (841/940) of patients had data available on VL rates. The mean CVL was 579 copies/mL pre-implementation and this decreased to 33 copies/mL post-implementation (Kruskal-Wallis < 0.001). The mean CVL decreased for all variables investigated post-implementation of the treatment strategy (P < 0.05). The undetectable VL (≤400 copies/mL) rate pre-implementation period was 50.0% which increased to 84.7% post-implementation (P < 0.001). The mean CVL at the county level significantly decreased in each county post-implementation (Kruskal-Wallis < 0.05). CONCLUSION: Our study confirmed a population-level association between increased ART coverage and decreased mean CVL; overall 84.7% of HIV infected MSM had an undetectable VL and were no longer infectious. BioMed Central 2018-02-01 /pmc/articles/PMC5796494/ /pubmed/29390979 http://dx.doi.org/10.1186/s12879-017-2927-2 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
He, Lin
Yang, Jiezhe
Ma, Qiaoqin
Zhang, Jiafeng
Xu, Yun
Xia, Yan
Chen, Wanjun
Wang, Hui
Zheng, Jinlei
Jiang, Jun
Luo, Yan
Xu, Ke
Zhang, Xingliang
Xia, Shichang
Pan, Xiaohong
Reduction in HIV community viral loads following the implementation of a “Treatment as Prevention” strategy over 2 years at a population-level among men who have sex with men in Hangzhou, China
title Reduction in HIV community viral loads following the implementation of a “Treatment as Prevention” strategy over 2 years at a population-level among men who have sex with men in Hangzhou, China
title_full Reduction in HIV community viral loads following the implementation of a “Treatment as Prevention” strategy over 2 years at a population-level among men who have sex with men in Hangzhou, China
title_fullStr Reduction in HIV community viral loads following the implementation of a “Treatment as Prevention” strategy over 2 years at a population-level among men who have sex with men in Hangzhou, China
title_full_unstemmed Reduction in HIV community viral loads following the implementation of a “Treatment as Prevention” strategy over 2 years at a population-level among men who have sex with men in Hangzhou, China
title_short Reduction in HIV community viral loads following the implementation of a “Treatment as Prevention” strategy over 2 years at a population-level among men who have sex with men in Hangzhou, China
title_sort reduction in hiv community viral loads following the implementation of a “treatment as prevention” strategy over 2 years at a population-level among men who have sex with men in hangzhou, china
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5796494/
https://www.ncbi.nlm.nih.gov/pubmed/29390979
http://dx.doi.org/10.1186/s12879-017-2927-2
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