In married couples, where one partner is HIV-positive and the other is not, antiretroviral therapy (ART) does not lower the risk of HIV transmission to the uninfected partner, says a Chinese study.
The research has raised questions as to the real-world effectiveness of the so-called Test-And-Treat strategy-treating HIV-positive persons with ART drugs in an effort to prevent new cases of HIV infection.
Led by Lu Wang of the Chinese Center for Disease Control and Prevention, the study included 1,927 married couples in the city of Zhumadian, Henan Province.
The couples were initially "serodiscordant," meaning that one partner had HIV while the other did not.
The initially seronegative spouses were monitored regularly for "seroconversion"-that is, conversion from HIV-negative to HIV-positive.
The seroconversion rate was relatively low: over a median follow-up of three years, 4.3 percent of spouses became HIV-positive. The seroconversion rate increased over time.
The risk of HIV transmission was higher for couples who reported more frequent sexual activity and especially for those who said they did not always use condoms.
Risk was also higher for spouses who scored lower on a psychological questionnaire. The results suggest that education-particularly on the need for consistent condom use-may play an important role in preventing transmission from HIV-positive persons to their HIV-negative partners. Efforts to target psychosocial factors may also be helpful.
Just as important, the use of ART did not lower the risk of HIV transmission to the initially HIV-negative spouse.
Risk did appear lower for couples in which the HIV-positive spouse did not switch his or her ART regimen during follow-up.
In previous studies, ART significantly lowered the rate of HIV transmission in serodiscordant couples, which generally received close medical follow-up. In contrast, the Chinese study shows no reduction in HIV transmission-even though all couples had access to health care services, including ART drugs.
The findings were published in the Journal of Acquired Immune Deficiency Syndromes.