Using Plasma Viral Load to Guide Antiretroviral Therapy Initiation to Prevent HIV-1 Transmission

Pamela M. Murnane, James P. Hughes, Connie Celum, Jairam R. Lingappa, Nelly Mugo, Carey Farquhar, James Kiarie, Anna Wald, Jared M. Baeten, Jairam Lingappa, Mary Campbell, Lawrence Corey, Robert W. Coombs, Amalia Magaret, M. Juliana McElrath, Rhoda Morrow, James I. Mullins, Kenneth Fife, Kenneth Fife, Edwin Were & 24 others Max Essex, Joseph Makhema, Elly Katabira, Allan Ronald, Susan Allen, Kayitesi Kayitenkore, Etienne Karita, Elizabeth Bukusi, Craig Cohen, Susan Allen, William Kanweka, Susan Allen, Bellington Vwalika, Saidi Kapiga, Rachel Manongi, Grace John-Stewart, Susan Allen, Mubiana Inambao, Sinead Delany-Moretlwe, Helen Rees, Guy de Bruyn, Glenda Gray, James McIntyre, Nelly Rwamba Mugo

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

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.

Original languageEnglish
Article numbere51192
JournalPLoS One
Volume7
Issue number11
DOIs
StatePublished - Nov 30 2012

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viral load
Human immunodeficiency virus 1
Viral Load
HIV-1
Plasmas
therapeutics
CD4 Lymphocyte Count
Guidelines
Therapeutics
Heterosexuality
sexual behavior
Costs
Sexual Behavior
pathogenicity
Costs and Cost Analysis
gender

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Murnane, P. M., Hughes, J. P., Celum, C., Lingappa, J. R., Mugo, N., Farquhar, C., ... Rwamba Mugo, N. (2012). Using Plasma Viral Load to Guide Antiretroviral Therapy Initiation to Prevent HIV-1 Transmission. PLoS One, 7(11), [e51192]. https://doi.org/10.1371/journal.pone.0051192

Using Plasma Viral Load to Guide Antiretroviral Therapy Initiation to Prevent HIV-1 Transmission. / Murnane, Pamela M.; Hughes, James P.; Celum, Connie; Lingappa, Jairam R.; Mugo, Nelly; Farquhar, Carey; Kiarie, James; Wald, Anna; Baeten, Jared M.; Lingappa, Jairam; Campbell, Mary; Corey, Lawrence; Coombs, Robert W.; Magaret, Amalia; Juliana McElrath, M.; Morrow, Rhoda; Mullins, James I.; Fife, Kenneth; Fife, Kenneth; Were, Edwin; Essex, Max; Makhema, Joseph; Katabira, Elly; Ronald, Allan; Allen, Susan; Kayitenkore, Kayitesi; Karita, Etienne; Bukusi, Elizabeth; Cohen, Craig; Allen, Susan; Kanweka, William; Allen, Susan; Vwalika, Bellington; Kapiga, Saidi; Manongi, Rachel; John-Stewart, Grace; Allen, Susan; Inambao, Mubiana; Delany-Moretlwe, Sinead; Rees, Helen; de Bruyn, Guy; Gray, Glenda; McIntyre, James; Rwamba Mugo, Nelly.

In: PLoS One, Vol. 7, No. 11, e51192, 30.11.2012.

Research output: Contribution to journalArticle

Murnane, PM, Hughes, JP, Celum, C, Lingappa, JR, Mugo, N, Farquhar, C, Kiarie, J, Wald, A, Baeten, JM, Lingappa, J, Campbell, M, Corey, L, Coombs, RW, Magaret, A, Juliana McElrath, M, Morrow, R, Mullins, JI, Fife, K, Fife, K, Were, E, Essex, M, Makhema, J, Katabira, E, Ronald, A, Allen, S, Kayitenkore, K, Karita, E, Bukusi, E, Cohen, C, Allen, S, Kanweka, W, Allen, S, Vwalika, B, Kapiga, S, Manongi, R, John-Stewart, G, Allen, S, Inambao, M, Delany-Moretlwe, S, Rees, H, de Bruyn, G, Gray, G, McIntyre, J & Rwamba Mugo, N 2012, 'Using Plasma Viral Load to Guide Antiretroviral Therapy Initiation to Prevent HIV-1 Transmission', PLoS One, vol. 7, no. 11, e51192. https://doi.org/10.1371/journal.pone.0051192
Murnane PM, Hughes JP, Celum C, Lingappa JR, Mugo N, Farquhar C et al. Using Plasma Viral Load to Guide Antiretroviral Therapy Initiation to Prevent HIV-1 Transmission. PLoS One. 2012 Nov 30;7(11). e51192. https://doi.org/10.1371/journal.pone.0051192
Murnane, Pamela M. ; Hughes, James P. ; Celum, Connie ; Lingappa, Jairam R. ; Mugo, Nelly ; Farquhar, Carey ; Kiarie, James ; Wald, Anna ; Baeten, Jared M. ; Lingappa, Jairam ; Campbell, Mary ; Corey, Lawrence ; Coombs, Robert W. ; Magaret, Amalia ; Juliana McElrath, M. ; Morrow, Rhoda ; Mullins, James I. ; Fife, Kenneth ; Fife, Kenneth ; Were, Edwin ; Essex, Max ; Makhema, Joseph ; Katabira, Elly ; Ronald, Allan ; Allen, Susan ; Kayitenkore, Kayitesi ; Karita, Etienne ; Bukusi, Elizabeth ; Cohen, Craig ; Allen, Susan ; Kanweka, William ; Allen, Susan ; Vwalika, Bellington ; Kapiga, Saidi ; Manongi, Rachel ; John-Stewart, Grace ; Allen, Susan ; Inambao, Mubiana ; Delany-Moretlwe, Sinead ; Rees, Helen ; de Bruyn, Guy ; Gray, Glenda ; McIntyre, James ; Rwamba Mugo, Nelly. / Using Plasma Viral Load to Guide Antiretroviral Therapy Initiation to Prevent HIV-1 Transmission. In: PLoS One. 2012 ; Vol. 7, No. 11.
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abstract = "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.",
author = "Murnane, {Pamela M.} and Hughes, {James P.} and Connie Celum and Lingappa, {Jairam R.} and Nelly Mugo and Carey Farquhar and James Kiarie and Anna Wald and Baeten, {Jared M.} and Jairam Lingappa and Mary Campbell and Lawrence Corey and Coombs, {Robert W.} and Amalia Magaret and {Juliana McElrath}, M. and Rhoda Morrow and Mullins, {James I.} and Kenneth Fife and Kenneth Fife and Edwin Were and Max Essex and Joseph Makhema and Elly Katabira and Allan Ronald and Susan Allen and Kayitesi Kayitenkore and Etienne Karita and Elizabeth Bukusi and Craig Cohen and Susan Allen and William Kanweka and Susan Allen and Bellington Vwalika and Saidi Kapiga and Rachel Manongi and Grace John-Stewart and Susan Allen and Mubiana Inambao and Sinead Delany-Moretlwe and Helen Rees and {de Bruyn}, Guy and Glenda Gray and James McIntyre and {Rwamba Mugo}, Nelly",
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AU - Murnane, Pamela M.

AU - Hughes, James P.

AU - Celum, Connie

AU - Lingappa, Jairam R.

AU - Mugo, Nelly

AU - Farquhar, Carey

AU - Kiarie, James

AU - Wald, Anna

AU - Baeten, Jared M.

AU - Lingappa, Jairam

AU - Campbell, Mary

AU - Corey, Lawrence

AU - Coombs, Robert W.

AU - Magaret, Amalia

AU - Juliana McElrath, M.

AU - Morrow, Rhoda

AU - Mullins, James I.

AU - Fife, Kenneth

AU - Fife, Kenneth

AU - Were, Edwin

AU - Essex, Max

AU - Makhema, Joseph

AU - Katabira, Elly

AU - Ronald, Allan

AU - Allen, Susan

AU - Kayitenkore, Kayitesi

AU - Karita, Etienne

AU - Bukusi, Elizabeth

AU - Cohen, Craig

AU - Allen, Susan

AU - Kanweka, William

AU - Allen, Susan

AU - Vwalika, Bellington

AU - Kapiga, Saidi

AU - Manongi, Rachel

AU - John-Stewart, Grace

AU - Allen, Susan

AU - Inambao, Mubiana

AU - Delany-Moretlwe, Sinead

AU - Rees, Helen

AU - de Bruyn, Guy

AU - Gray, Glenda

AU - McIntyre, James

AU - Rwamba Mugo, Nelly

PY - 2012/11/30

Y1 - 2012/11/30

N2 - 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.

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