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Community Viral Load and CD4 Count Distribution Among People Living With HIV in a South African Township: Implications for Treatment as Prevention

Kranzer, Katharina PhD*,†; Lawn, Stephen D. MD*,†; Johnson, Leigh F. PhD; Bekker, Linda-Gail PhD; Prof†,§; Wood, Robin†,§

JAIDS Journal of Acquired Immune Deficiency Syndromes: 1 August 2013 - Volume 63 - Issue 4 - p 498–505
doi: 10.1097/QAI.0b013e318293ae48
Epidemiology and Prevention

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: katharina.kranzer@lshtm.ac.uk).

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

© 2013 by Lippincott Williams & Wilkins