Community Viral Load and CD4 Count Distribution Among People Living With HIV in a South African Township

Abstract

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 counts; 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 1144 (88.0%) of 1300 randomly selected individuals participated in the study. 260 tested positive, giving an HIV prevalence of 22.7% (95%CI:20.3-25.3). A third of all HIV-infected individuals (33.5%, 95%CI:27.8-39.6) reported taking ART. The median CD4 count was 417 cells/μl (IQR:285-627); 33 (12.7%, 95%CI:8.9-17.4) had a CD4 count of ≤200 cells/μL. VL measurements were available for 219 (84.2%) individuals and were undetectable in 72 (33.9%), >1500 copies/ml in 127 (58.0%) and >10,000 copies/ml in 96 (43.8%). Of those reporting they were receiving ART, 30.4% had a VL>1500 copies/ml compared to 58.0% of those reporting they were not receiving ART. Conclusion A small proportion of those living with HIV in this community had a CD4 count <200 cells/μl; 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.

HIV Infection in Turkey: How Close Are We to the Target?

“…Bunlardan birincisi, HIV-pozitif olgulara olabildiğince erken tanı konması ve tanı alanlarda hemen tedaviye başlanmasıdır. Kandaki virusun testlerle saptanamayacak kadar düşük düzeylere indirilmesi, hem hastalığın ilerlemesini engellemekte, hem de kişinin cinsel yolla bulaştırıcılığını ortadan kaldırmaktadır (28,(37)(38)(39). Ayrıca, HIV edinme riski yüksek olan bireylerde antiretroviral ilaçların korunma amacıyla kullanılmasının, HIV bulaşmasını önemli ölçüde önlediği de kanıtlanmıştır (40,41).…”

A comparison of self-report and antiretroviral detection to inform estimates of antiretroviral therapy coverage, viral load suppression and HIV incidence in Kwazulu-Natal, South Africa

“…Self-report has commonly been used in surveys to identify individuals on ART [1][2][3][4][5] but accuracy cannot be verified without an objective measure. ARV detection in dried blood spots (DBS) is an objective method to identify patients with recent ART exposure, but may not identify individuals on ART who have poor or irregular adherence to ART.…”

Immunological Profiles in HIV Positive Patients with or without Opportunistic Infections and the Influence of Highly Active Antiretroviral Therapy: A Systematic Review and Update

“…Among the research articles that satisfied the criteria for inclusion, 4 were cross-sectional based in nature [5,21,31,32], 8 were longitudinal studies [27,[33][34][35][36][37][38][39]], 5 were prospective cohort studies [40-44] whereas 2 studies involved use of both cross-sectional and longitudinal study designs [26,45]. Table 1 presents the types of studies, population among other variables included in our review.…”

“…Decline in CD4 + T cell counts during HIV infection is associated with the loss of T cell mediated responses, which has direct correlation with elevated HIV viral load [5,51]. T cell functional defects are seen during the early phase of infection, which is accompanied by the production of type 1 cytokines including; IFN-γ and IL-2 and thereafter persistence of type 2 cytokines mainly IL-4 and IL-10 [21,22].…”

“…Contrastingly, unlike the CD4 + cell moiety that gradually declines over time, the CD8 + cytotoxic T lymphocyte (CTLs) expansions persist until far advanced stages of HIV disease, when all T-cell numbers tend to fall [2,3]. Highly active antiretroviral therapy (HAART) is primarily used in controlling HIV replication with successful intervention being measured by an increase in baseline CD4 + T cell counts, reduction of CD8 + T cell numbers and significant decline in HIV viral load [4,5]. HIV viral load remains the preferred clinical parameter to monitor individuals on ART [6,7], arguably because it accurately detects virological failure prior to the manifestation of either immunological or clinical deterioration.…”