Early antiretroviral therapy on reducing HIV transmission in China: strengths, weaknesses and next focus of the program

Abstract

Early antiretroviral therapy (ART) initiation is a recommended public health approach for the prevention of HIV-1 transmission. In this cohort study, we included 13132 serodiscordant couples. ART was initiated for patients with CD4+ T cell counts less than 200 cells/uL, 350 cells/uL, and 500 cells/uL respectively. This divided the ART treated couples into three groups. Univariate and multivariate intention-to-treat analyses were performed to examine the association between the study groups. Early-ART initiation was associated with a 45% lower risk of partner infection than was late-ART initiation (AHR 0.55, 95% CI, 0.37–0.81). Mid-ART initiation was associated with a 39% lower risk of partner infection than was late-ART initiation (AHR 0.61, 95% CI, 0.48–0.78). However, the risk reduction between the early and mid-ART groups was not significant. Drug compliance (AHR 1.55, 95% CI 1.03–2.35) and increased baseline viral load (AHR 1.41, 95% CI 1.33–1.51) were associated with an increased risk of infections among partners in the treatment. Prevention of HIV transmission as a result of early ART initiation was feasible on national and regional scales; however, many factors, such as the motivation to commence ART, adherence, and attrition, may affect the impact of this strategy in programmatic settings.

HIV drug resistance in patients in China’s national HIV treatment programme who have been on first-line ART for at least 9 months

“…Three phases of ART were established according to development stages of NFATP in China: initial and scaleup ART, 2003-2008; standardization and scale-up, 2009-2012; and rapid scale-up, 2013-2015 [13][14][15]. Enormous efforts have been made to develop the capability of treating large numbers of people across wide geographic areas.…”

Efficacy and Tolerability of Lopinavir/Ritonavir- and Efavirenz-Based Initial Antiretroviral Therapy in HIV-1-Infected Patients in a Tertiary Care Hospital in Beijing, China

“…The China's National Free Antiretroviral Treatment Program (NFATP) was set up in 2003 and has significantly expanded access to ART in China. Morbidity and mortality in HIV-infected patients have decreased markedly in the last few years (AIDS and Hepatitis C Professional Group, 2018;Liu et al, 2018), but the availability of antiretroviral regimens remains limited in China, as in many developing countries.…”

“…EFV and LPV/r are no longer recommended as first-line treatments in most developed countries, because of their adverse effects (Gunthard et al, 2014), but they are still widely used in underdeveloped and developing countries (World Health Organization, 2014). In China, 471,140 patients were registered as receiving ART under the NFATP by the end of 2015 (Liu et al, 2018). TDF, AZT, 3TC, EFV, and LPV/r are the most important antiretroviral drugs in clinical use, especially for LPV/r which is the main PI included in the NFATP (AIDS Professional Group, 2015;AIDS and Hepatitis C Professional Group, 2018).…”

A Community-Based Social Marketing Strategy to Prevent HIV and Fight Stigma

“…Thirdly, reducing viral load through antiretroviral therapy can also help to limit the spread of HIV infection. In fact, people aware of their serological state who actually receive an effective treatment, usually show a severely reduced risk of transmitting the disease to others (Liu et al, 2018;Cates Jr., Chesney, & Cohen, 1997).…”