Treatment as prevention enrolling at least 75% of individuals on ART will be needed to significantly reduce HIV prevalence in a HIV cohort.
Adult
Anti-Retroviral Agents
/ therapeutic use
Cohort Studies
Emigrants and Immigrants
/ statistics & numerical data
Female
France
/ epidemiology
HIV Infections
/ drug therapy
Homosexuality, Male
/ statistics & numerical data
Humans
Male
Middle Aged
Models, Theoretical
Patient Participation
/ statistics & numerical data
Prevalence
Sex Characteristics
Unsafe Sex
/ statistics & numerical data
Young Adult
Antiretroviral therapy
HIV prevalence
Treatment as prevention
Journal
Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology
ISSN: 1873-5967
Titre abrégé: J Clin Virol
Pays: Netherlands
ID NLM: 9815671
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
received:
04
04
2019
revised:
01
07
2019
accepted:
23
08
2019
pubmed:
22
9
2019
medline:
20
6
2020
entrez:
22
9
2019
Statut:
ppublish
Résumé
"Treatment as Prevention" (TasP) aims to reduce new HIV infections through higher enrolment on suppressive antiretroviral therapy (ART). We studied the current epidemic and possible impact of TasP in a French HIV cohort including MSM and migrant subjects. Socio-demographic, clinical and laboratory variables were collected during the follow-up of 6995 HIV-infected patients. The numbers of individuals living with HIV in each year were estimated from diagnoses up to that year minus recorded deaths. Patients were classified according to gender, transmission mode, country of birth and treatment status. The cohort includes 6995 individuals diagnosed from 1985 to 2015, of whom 72% were men. Unprotected sexual intercourse was the main mode of transmission. Women were more likely to be migrants (45% versus 13%), whereas men were more likely to have been born in France (52% versus 27%). Diagnoses were more correlated with untreated than treated prevalence in each group. MSM diagnoses was strongly correlated to untreated prevalence whatever the country of birth (p < 0.0001). However, heterosexual diagnoses were better correlated with prevalence within individual country groups (b = 0.29 female diagnoses/year per untreated male born in France, compared to b = 0.73 for foreigners). Using these transmission rates, mathematical modelling estimated that enrolling 75% of untreated individuals per year would decrease diagnoses ten-fold by 2021. Enrolling at least 75% of individuals on ART is necessary to substantially impact numbers of new HIV infections in this cohort. Treatment as prevention will actually be effective to reduce HIV prevalence.
Sections du résumé
BACKGROUND
"Treatment as Prevention" (TasP) aims to reduce new HIV infections through higher enrolment on suppressive antiretroviral therapy (ART).
OBJECTIVES
We studied the current epidemic and possible impact of TasP in a French HIV cohort including MSM and migrant subjects.
STUDY DESIGN
Socio-demographic, clinical and laboratory variables were collected during the follow-up of 6995 HIV-infected patients. The numbers of individuals living with HIV in each year were estimated from diagnoses up to that year minus recorded deaths. Patients were classified according to gender, transmission mode, country of birth and treatment status.
RESULTS
The cohort includes 6995 individuals diagnosed from 1985 to 2015, of whom 72% were men. Unprotected sexual intercourse was the main mode of transmission. Women were more likely to be migrants (45% versus 13%), whereas men were more likely to have been born in France (52% versus 27%). Diagnoses were more correlated with untreated than treated prevalence in each group. MSM diagnoses was strongly correlated to untreated prevalence whatever the country of birth (p < 0.0001). However, heterosexual diagnoses were better correlated with prevalence within individual country groups (b = 0.29 female diagnoses/year per untreated male born in France, compared to b = 0.73 for foreigners). Using these transmission rates, mathematical modelling estimated that enrolling 75% of untreated individuals per year would decrease diagnoses ten-fold by 2021.
CONCLUSIONS
Enrolling at least 75% of individuals on ART is necessary to substantially impact numbers of new HIV infections in this cohort. Treatment as prevention will actually be effective to reduce HIV prevalence.
Identifiants
pubmed: 31541773
pii: S1386-6532(19)30189-1
doi: 10.1016/j.jcv.2019.08.010
pii:
doi:
Substances chimiques
Anti-Retroviral Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
27-32Informations de copyright
Copyright © 2019 Elsevier B.V. All rights reserved.