MSF Survey Shows High Viral Load in Men and People with CD4 500-75

SEATTLE/NEW YORK—Among individuals not receiving antiretroviral treatment, men had twice the level of HIV virus in their blood as women at the same stage in the disease, according to one of the major findings of a three-country Doctors Without Borders/Médecins Sans Frontières (MSF) population survey presented at the Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle Wednesday.

“High viral load greatly increases the risk of HIV transmission,” said David Maman, lead researcher on the survey. “This difference in viral load levels between men and women could help explain why incidence is so high among women, and points to potential ways to bring down new infections. To cut down rates among women, it could be critical to test and treat men even earlier.”

The surveys were conducted in Ndhiwa (Kenya), Chiradzulu, (Malawi), and Eshowe (South Africa) between September 2012 and November 2013. In total, 9,802 houses were visited and 19,006 individuals ages 15 to 59 were included and tested for HIV. All those who tested positive had their viral load and CD4 assessed.

Another major finding of the survey was that it showed that people with CD4 counts between 500 and 749 had three times the viral load of people with higher counts, more than 750 cells/mm3, highlighting an acceleration of the viral replication at early stages of the disease. WHO recommendations updated in 2013 encourage all countries to initiate treatment in people living with HIV when their CD4 cell count falls to 500 cells/mm3 or less.

“This is the first time we have information about both viral load and CD4 at the community or population level,” Maman said. “It suggests that testing and antiretroviral treatment at higher CD4 thresholds—particularly for men—could contribute to a decrease in overall HIV transmission rates in many places."