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Antiretroviral Therapy Reduces HIV Transmission in Discordant Couples in Rural Yunnan, China.doc

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Antiretroviral Therapy Reduces HIV Transmission in Discordant Couples in Rural Yunnan, China

AntiretroviralTherapyReducesHIVTransmissionin DiscordantCouplesinRuralYunnan,China NaHe1,SongDuan2,YingyingDing1,KemingRou3,JenniferM.McGoogan3,ManhongJia4, YuechengYang2,JibaoWang2,JulioS.G.Montaner5,ZunyouWu3*,fortheChinaNationalHIV PreventionStudyGroup 1Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China, 2Dehong Prefecture Center for Disease Control and Prevention, Mangshi, Yunnan Province, China, 3National Center for AIDS/STD Control and Prevention (NCAIDS), ChineseCenterforDiseaseControlandPrevention(ChinaCDC),Beijing,China,4YunnanProvincialCenterforDiseaseControlandPrevention,Kunming,YunnanProvince, China,5BritishColombiaCentreforExcellenceinHIV/AIDS,StPaul’sHospital,andDivisionofAIDS,FacultyofMedicine,UniversityofBritishColumbia,Vancouver,Canada Abstract Background: Although HIV treatment as prevention (TasP) via early antiretroviral therapy (ART) has proven to reduce transmissionsamongHIV-serodiscordantcouples,itsfullimplementationindevelopingcountriesremainsachallenge.In thisstudy,wedeterminewhetherChina’scurrentHIVtreatmentprogrampreventsnewHIVinfectionsamongdiscordant couplesinruralChina. Methods:Aprospective,longitudinalcohortstudywasconductedfromJune2009toMarch2011,inruralYunnan.Atotalof 1,618HIV-discordantcoupleswereeligible,1,101wereenrolled,and813werefollowedforanaverageof1.4person-years (PY).RoutineART wasprescribedtoHIV-positivespouses according toeligibility(CD4,350cells/ml). Seroconversionwas usedtodetermineHIVincidence. Results:Atotalof17seroconversionsweredocumentedwithin1,127PYoffollow-up,foranoverallincidenceof1.5per100 PY.Epidemiologicalandgeneticevidenceconfirmedthatall17seroconverterswereinfectedviamaritalsecondarysexual transmission.HavinganART-experiencedHIV-positivepartnerwasassociatedwithalowerrateofseroconvertioncompared withhavinganART-na?¨veHIV-positivepartner(0.8per100PYvs.2.4per100PY,HR=0.34,95%CI=0.12–0.97,p=0.0436).