Early HIV treatment and survival over six years of observation in the ANRS 12249 treatment as prevention trial

2022

Article

Baisley K., Orne-Gliemann J., Larmarange Joseph, Plazy M., Collier D., Dreyer J., Mngomezulu T., Herbst K., Hanekom W., Dabis F., Siedner M.J., Iwuji C.

HIV Medicine, 2022, 23 (8), 922-928 ISSN 1464-2662

Objectives : Population- based universal test and treat (UTT) trials have shown an impact on population- level virological suppression. We followed the ANRS 12249 TasP trial population for 6 years to determine whether the intervention had longer- term survival benefits. Methods: The TasP trial was a cluster-randomized trial in South Africa from 2012 to 2016. All households were offered 6- monthly home- based HIV testing. Immediate antiretroviral therapy (ART) was offered through trial clinics to all people living with HIV (PLHIV) in intervention clusters and according to na-tional guidelines in control clusters. After the trial, individuals attending the trial clinics were transferred to the public ART programme. Deaths were ascertained through annual demographic surveillance. Random- effects Poisson regression was used to estimate the effect of trial arm on mortality among (i) all PLHIV; (ii) PLHIV aware of their status and not on ART at trial entry; and (iii) PHLIV who started ART during the trial. Results: Mortality rates among PLHIV were 9.3/1000 and 10.4/1000 person- years in the control and intervention arms, respectively. There was no evidence hat the intervention decreased mortality among all PLHIV [adjusted rate ratio (aRR) = 1.10, 95% confidence interval (CI) = 0.85- 1.43, p = 0.46] or among PLHIV who were aware of their status but not on ART. Among individuals who initiated ART, the intervention decreased mortality during the trial (aRR = 0.49, 95% CI = 0.28- 0.85, p = 0.01), but not after the trial ended. Conclusions: The 'treat all' strategy reduced mortality among individuals who started ART but not among all PLHIV. To achieve maximum benefit of immedi-ate ART, barriers to ART uptake and retention in care need to be addressed.

Médecine [050MEDECI] ; Maladies sexuellement transmissibles [052MALTRA03] ; Politique sociale, problèmes sociaux [106PROSO] ; Démographie, population [108DEMOG1]

Fonds IRD [F B010087012]

fdi:010087012