Introduction: The goals of scale-up of antiretroviral therapy (ART) have expanded from prevention of morbidity and death to include prevention of transmission. Morbidity and mortality risk are associated with CD4 count; transmission risk depends on plasma viral load (VL). This study aimed to describe CD4 count and VL distributions among HIV-infected individuals in a South African township to gain insights into the potential impact of ART scale-up on community HIV transmission risk.
Methods: A random sample of 10% of the adult population was invited to attend an HIV testing service. Study procedures included a questionnaire, HIV testing, CD4 count, and VL testing.
Results: One thousand one hundred forty-four (88.0%) of 1300 randomly selected individuals participated in the study. Two hundred sixty tested positive, giving an HIV prevalence of 22.7% [95% confidence interval (CI): 20.3 to 25.3]. A third of all HIV-infected individuals (33.5%, 95% CI: 27.8 to 39.6) reported taking ART. The median CD4 count was 417 cells per microliter (interquartile range, 285–627); 33 (12.7%, 95% CI: 8.9 to 17.4) had a CD4 count of ≤200 cells per microliter. VL measurements were available for 219 individuals (84.2%) and were undetectable in 72 (33.9%), >1500 copies per milliliter in 127 (58.0%) and >10,000 copies per milliliter in 96 (43.8%). Of those reporting they were receiving ART, 30.4% had a VL >1500 copies per milliliter compared with 58.0% of those reporting they were not receiving ART.
Conclusions: A small proportion of those living with HIV in this community had a CD4 count of <200 cells per microliter; more than half had a VL high enough to be associated with considerable transmission risk. A substantial proportion of HIV-infected individuals remained at risk of transmitting HIV even after starting ART.
*Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom;
†The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Science, University of Cape Town, Cape Town, South Africa;
‡Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa; and
§Department of Medicine, Faculty of Health Science, University of Cape Town, Cape Town, South Africa.
Correspondence to: Katharina Kranzer, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT London, United Kingdom (e-mai: firstname.lastname@example.org).
K. K. (087262/Z/08/Z) and S. D. L. (088590/Z/09/Z) are funded by the Wellcome Trust, London, United Kingdom. R. W. is funded by IeDEA (International epidemiologic databases to evaluate AIDS) and CEPAC (Cost-effectiveness of Preventing AIDS Complications). L.-G. B. is funded by the National Institutes of Health CIPRA (Comprehensive International Program for Research on AIDS).
The authors have no conflicts of interest to disclose.
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Received November 26, 2012
Accepted February 21, 2013