Skip to content
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Menu
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Menu
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Using Plasma Viral Load to Guide Antiretroviral Therapy Initiation to Prevent HIV-1 Transmission
PLoS ONE, Volume 7, No. 11, Article e51192, Year 2012
Notification
URL copied to clipboard!
Description
Background: Current WHO guidelines recommend antiretroviral therapy (ART) initiation at CD4 counts ≤350 cells/μL. Increasing this threshold has been proposed, with a primary goal of reducing HIV-1 infectiousness. Because the quantity of HIV-1 in plasma is the primary predictor of HIV-1 transmission, consideration of plasma viral load in ART initiation guidelines is warranted. Methods: Using per-sex-act infectivity estimates and cross-sectional sexual behavior data from 2,484 HIV-1 infected persons with CD4 counts >350 enrolled in a study of African heterosexual HIV-1 serodiscordant couples, we calculated the number of transmissions expected and the number potentially averted under selected scenarios for ART initiation: i) CD4 count <500 cells/μL, ii) viral load ≥10,000 or ≥50,000 copies/mL and iii) universal treatment. For each scenario, we estimated the proportion of expected infections that could be averted, the proportion of infected persons initiating treatment, and the ratio of these proportions. Results: Initiating treatment at viral load ≥50,000 copies/mL would require treating 19.8% of infected persons with CD4 counts >350 while averting 40.5% of expected transmissions (ratio 2.0); treating at viral load ≥10,0000 copies/mL had a ratio of 1.5. In contrast, initiation at CD4 count <500 would require treating 41.8%, while averting 48.4% (ratio 1.1). Conclusion: Inclusion of viral load in ART initiation guidelines could permit targeting ART resources to HIV-1 infected persons who have a higher risk of transmitting HIV-1. Further work is needed to estimate costs and feasibility. © 2012 Murnane et al.
Authors & Co-Authors
Murnane, Pamela M.
United States, Seattle
University of Washington
Hughes, James P.
United States, Seattle
University of Washington
Celum, Connie L.
United States, Seattle
University of Washington
Lingappa, Jairam R.
United States, Seattle
University of Washington
Mugo, Nelly Rwamba
United States, Seattle
University of Washington
Kenya, Nairobi
University of Nairobi
Kenya, Nairobi
Kenyatta National Hospital
Farquhar, Carey
United States, Seattle
University of Washington
Kiarie, James Njogu
United States, Seattle
University of Washington
Kenya, Nairobi
University of Nairobi
Kenya, Nairobi
Kenyatta National Hospital
Wald, Anna
United States, Seattle
University of Washington
United States, Seattle
Fred Hutchinson Cancer Research Center
Baeten, Jared M.
United States, Seattle
University of Washington
Campbell, Mary S.
United States, Seattle
University of Washington
Corey, Lawrence
United States, Seattle
University of Washington
Coombs, Robert W.
United States, Seattle
University of Washington
Magaret, Amalia Meier
United States, Seattle
University of Washington
Juliana McElrath, M.
United States, Seattle
University of Washington
Morrow, Rhoda Ashley
United States, Seattle
University of Washington
Mullins, James I.
United States, Seattle
University of Washington
Coetzee, David John
South Africa, Cape Town
University of Cape Town
Fife, Kenneth H.
Kenya, Eldoret
Moi University
United States, Bloomington
Indiana University Bloomington
Were, Edwin O.
Kenya, Eldoret
Moi University
United States, Bloomington
Indiana University Bloomington
Essex, Max E.
Botswana, Gaborone
Botswana Harvard Aids Institute Partnership
Makhema, Joseph M.
Botswana, Gaborone
Botswana Harvard Aids Institute Partnership
Katabira, Elly Tebasoboke
Uganda, Kampala
Makerere University
Ronald, Allan R.
Uganda, Kampala
Makerere University
Ronald, Allan R.
Rwanda, Kigali
Rwanda Zambia Hiv Research Group
Zambia, Lusaka
Rwanda Zambia Hiv Research Group
Zambia, Ndola
Rwanda Zambia Hiv Research Group
United States, Atlanta
Emory University
Allen, Susan A.
Rwanda, Kigali
Rwanda Zambia Hiv Research Group
United States, Atlanta
Emory University
Karita, Etienne
Rwanda, Kigali
Rwanda Zambia Hiv Research Group
United States, Atlanta
Emory University
Bukusi, Elizabeth Anne
Kenya, Nairobi
Kenya Medical Research Institute
United States, San Francisco
University of California, San Francisco
Cohen, Craig R.
Kenya, Nairobi
Kenya Medical Research Institute
United States, San Francisco
University of California, San Francisco
Kanweka, William
Zambia, Lusaka
Rwanda Zambia Hiv Research Group
United States, Atlanta
Emory University
Vwalika, Bellington
Zambia, Lusaka
Rwanda Zambia Hiv Research Group
United States, Atlanta
Emory University
Kapiga, Saidi Hussein
Tanzania, Moshi
Kilimanjaro Christian Medical University College
United States, Cambridge
Harvard University
Manongi, Rachel N.
Tanzania, Moshi
Kilimanjaro Christian Medical University College
United States, Cambridge
Harvard University
John-Stewart, Grace C.
Kenya, Nairobi
University of Nairobi
United States, Seattle
University of Washington
Inambao, Mubiana
Zambia, Ndola
Rwanda Zambia Hiv Research Group
United States, Atlanta
Emory University
Delany-Moretlwe, Sinead
South Africa, Johannesburg
University of the Witwatersrand
Rees, Helen V.
South Africa, Johannesburg
University of the Witwatersrand
de Bruyn, Guy
South Africa, Johannesburg
University of the Witwatersrand
Gray, Glenda E.
South Africa, Johannesburg
University of the Witwatersrand
McIntyre, James Alasdair
South Africa, Johannesburg
University of the Witwatersrand
Rwamba Mugo, Nelly
Kenya, Nairobi
University of Nairobi
United States, Seattle
University of Washington
Statistics
Citations: 40
Authors: 40
Affiliations: 18
Identifiers
Doi:
10.1371/journal.pone.0051192
e-ISSN:
19326203
Research Areas
Infectious Diseases
Sexual And Reproductive Health
Study Design
Cross Sectional Study