Dramatic increase in HIV prevalence after scale-up of antiretroviral treatment

作者：Zaidi Jaffer^*; Grapsa Erofili; Tanser Frank; Newell Marie Louise; Baernighausen Till

来源：AIDS, 2013, 27(14): 2301-2305.

DOI：10.1097/QAD.0b013e328362e832

• antiretroviral treatment
• HIV prevalence
• HIV surveillance
• KwaZulu-Natal
• population-based longitudinal cohort study

Objectives:To investigate HIV prevalence trends in a rural South African community after the scale-up of antiretroviral treatment (ART) in 2004. %26lt;br%26gt;Methods:We estimated adult HIV prevalence (ages 15-49 years) using data from a large, longitudinal, population-based HIV surveillance in rural KwaZulu-Natal, South Africa, over the period from 2004 (the year when the public-sector ART scale-up started) to 2011. We control for selection effects due to surveillance nonparticipation using multiple imputation. We further linked the surveillance data to patient records from the local HIV treatment program to estimate ART coverage. %26lt;br%26gt;Results:ART coverage of all HIV-infected people in this community increased from 0% in 2004 to 31% in 2011. Over the same observation period adult HIV prevalence increased steadily from 21 to 29%. The change in overall HIV prevalence is nearly completely explained by an increase of HIV-infected people receiving ART, and it is largely driven by increases in HIV prevalence in women and men older than 24 years. %26lt;br%26gt;Conclusion:The observed dramatic increase in adult HIV prevalence can most likely be explained by increased survival of HIV-infected people due to ART. Future studies should decompose HIV prevalence trends into HIV incidence and HIV-specific mortality changes to further improve the causal attribution of prevalence increases to treatment success rather than prevention failure.

• 出版日期2013-9-10