Using HIV Viral Load to Guide Treatment-for-Prevention Interventions

In a paper published in the March issue of Current Opinion in HIV & AIDS, HAI researchers Max Essex and Vlad Novitsky provide evidence that HIV-1 RNA load can guide treatment-for-prevention interventions to slow the AIDS epidemic.

Some HIV-infected individuals maintain increased levels of HIV-1 RNA load after acute infection for an extended period of time. These people can disproportionately contribute to the spread of HIV in the community. The level of HIV-1 RNA load is the major predictor of HIV transmission. HIV-infected individuals who maintain increased levels of HIV-1 RNA transmit the virus at higher rates.

Antiretroviral treatment (ART) decreases HIV replication, thus reducing rates of virus transmission. The recent HPTN 052 study demonstrated a 96% efficacy for initiation of early ART in HIV-1 serodiscordant couples (in which one partner is infected with HIV and the other is not).

Identifying people with a high viral load and placing them on ART could be an effective strategy that has the potential to achieve both individual benefits by lowering the risk for early onset of clinical AIDS and public health benefits by reducing HIV transmission.

The Botswana–Harvard Partnership is currently conducting a clinical trial in the Botswana village of Mochudi to test the effectiveness of identifying and treating individuals with a high viral load. If successful, the approach used in the Mochudi Prevention Project could be used widely to control the HIV/AIDS epidemic.