High Transmitter Cd4+T-Cell Count Shortly After The Time Of Transmission In A Study Of African Serodiscordant Couples

Background2013 WHO guidelines recommend starting ART at CD4+ T-cell counts <= 500 cells/mu L. We present the T-cell counts from adult Africans with HIV shortly following transmission to their sexual partners.MethodsHIV-discordant couples in Zambia, Uganda and Rwanda were followed prospectively and received couples counseling and condoms. HIV uninfected partners were tested for HIV at least quarterly and HIV-infected partners received HIV care and referral for ART per national guidelines. Upon diagnosis of incident HIV infection in the previously HIV-uninfected partner, a blood sample was collected from both partners to measure CD4+ T-cells and perform viral linkage. The estimated date of infection (EDI) of the incident case was calculated based on testing history. EDI was unknown for suspected transmitting partners.ResultsFrom 2006-2011, 4,705 HIV-discordant couples were enrolled in this cohort, and 443 cases of incident HIV infection were documented. Virus linkage analysis was performed in 374 transmission pairs, and 273 (73%) transmissions were linked genetically. CD4 counts in the transmitting partner were measured a median of 56 days after EDI (mean:90.5, min:10, max:396). The median CD4 count was 339 cells/mu l (mean:386.4, min:15,max:1,434), and the proportion of partners with a CD4+ T-cell count above 500/mu l was 25% (95% CI:21, 31).ConclusionsIn our cohort of discordant couples, 73% of HIV transmissions occurred within the relationship, and the transmitter CD4+ T-cell count shortly after the transmission event was frequently higher than the WHO 2013 ART-initiation guidelines.