Marcia Frellick

March 07, 2014

BOSTON — HIV infections are declining in areas of sub-Saharan Africa where antiretroviral treatment has been expanded, results from 2 new studies by Epicentre, the research branch of Doctors Without Borders, show.

The work, released here at the 2014 Conference on Retroviruses and Opportunistic Infections, is among the first to look at the effect of a large-scale rollout of antiretrovirals in regions of Africa with some of the highest HIV prevalence in the world.

The first study, known as the Chiradzulu HIV Impact in Population Study (CHIPS), was conducted in Malawi, where 17% of the population is reportedly infected with HIV. A large-scale rollout of antiretrovirals by the Ministry of Health and Doctors Without Borders began there in 2001, and treatment coverage has risen to 65.8%. The cross-sectional population-based survey, conducted in 2013, showed a very low level of new infections — just 0.4%.

Of the total surveyed HIV-positive population, 61.8% had undetectable levels of HIV (below 1000 copies/mL). This is more than twice the level of viral suppression in the HIV-positive population in the United States, which was 25.0% in 2012, the researchers note.

The second study was conducted in South Africa's KwaZulu-Natal province, where the HIV prevalence of 25.0% is among the highest in the world. Wide-scale antiretrovirals were rolled out in 2009. Viral suppression was achieved in 89.6% of people who were receiving therapy for more than 6 months. Despite the high overall prevalence, the incidence rate was moderate (1.2% a year), indicating that treatment is likely helping to cut the number of new infections. Among all individuals, 81.4% said they had undergone a previous HIV test (88.4% of women and 69.8% of men).

Sex Imbalance

The prevalence of HIV in women is double that of men, the researchers report. Women 30 to 40 years of age had the highest prevalence rate (56%). Women 20 to 30 years had the highest incidence of new infections, at 4%; this is 4 times the rate in men of the same age. Three quarters of the HIV-positive people in need of antiretrovirals were on treatment, and coverage was better in women than in men (78.5% vs 63.9%). Viral suppression levels hit 89.6% for people receiving therapy for more than 6 months.

Helena Huerga, MD, from Epicentre Paris, who was lead researcher on the study, said these results emphasize the importance of large-scale efforts to get antiretrovirals to the people who need them, and give researchers a much better picture of the population sectors to target.

The number of new infections in women is "alarming," said Jeffrey Klausner, MD, from the University of California at Los Angeles. This area requires an emergent response, he told Medscape Medical News.

"Those high rates strongly suggest the need to accelerate the scale-up with current well-proven effective combination prevention interventions, like frequent testing, oral pre-exposure prophylaxis, male circumcision, and sexually transmitted infection treatment," he said.

Emily Wong, MD, an instructor at Harvard Medical School in Boston, whose research is based at the KwaZulu-Natal Research Institute for Tuberculosis and HIV in Durban, South Africa, said she agrees. "It really highlights the need to direct intense — and maybe new — prevention strategies at the young age group to try to end this surge of HIV incidence in young women," she said.

Dr. Huerga, Dr. Klausner, and Dr. Wong have disclosed no relevant financial relationships.

2014 Conference on Retroviruses and Opportunistic Infections (CROI). Presented March 6, 2014.

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