Botswana study shows 96 percent rate of viral suppression for patients on HIV drugs

March 23, 2016
HIV (yellow) infecting a human immune cell. Credit: Seth Pincus, Elizabeth Fischer and Austin Athman, National Institute of Allergy and Infectious Diseases, National Institutes of Health

Botswana appears to have achieved very high rates of HIV diagnosis, treatment, and viral suppression—much better than most Western nations, including the United States—according to a new study from Harvard T.H. Chan School of Public Health and colleagues in Botswana. The findings suggest that even in countries with limited resources where a large percentage of the population is infected with HIV, strong treatment programs can help make significant headway against the HIV/AIDS epidemic.

The study will be published online March 23, 2016 in The Lancet HIV.

"By now, we hoped to have an HIV vaccine. That hasn't happened. Ironically, treatment of HIV-infected persons may be our most effective, efficient way to prevent new infections. These results show that Botswana has made great progress in reducing the number of people who are infectious to others," said Max Essex, Mary Woodard Lasker Professor of Health Sciences, chair of the Harvard T.H. Chan School of Public Health AIDS Initiative, and chair of the Botswana Harvard AIDS Institute Partnership.

Global HIV programs have continued to face challenges in achieving the of testing and treatment needed to optimize health and reduce new infections. Mounting evidence suggests that providing antiretroviral treatment (ART) to all people living with HIV, regardless of the stage of their disease, can help. In 2014, the Joint United Nations Programme on HIV/AIDS (UNAIDS) proposed new testing and treatment targets: that 90% of all people living with HIV know their HIV status; that 90% diagnosed with HIV be given ART; and that 90% who receive treatment have virologic suppression—very low blood levels of HIV—by the year 2020.

The researchers looked at the achievability of the UNAIDS targets in Botswana—a middle-income African nation where 25% of the population aged 15-49 is HIV positive but which also has a mature public ART program—by directly measuring HIV status, treatment, and viral suppression among 12,610 people from 30 communities across the country between October 2013 and November 2015. Study participants were drawn from a large, ongoing HIV prevention study in Botswana. The participants responded to a questionnaire, had their blood tested for HIV if their status wasn't known, and, if they were infected with HIV, their viral load was checked.

Out of the 12,610 participants, 3,596 (29%) were HIV infected and 2,995 (83.3%) of these individuals already knew their HIV status. Among those who knew their status, 2,617 (87.4%) were receiving ART.

Significantly, the study authors called it "remarkable" that of the 2,609 people receiving ART who had their viral load checked, 2,517 (96.5%) had viral suppression.

Until now, there has been considerable uncertainty as to whether the ambitious targets proposed by UNAIDS can be achieved, especially in countries with limited resources where the HIV burden is highest, according to the study authors. But the new findings suggest that Botswana could meet and even exceed the targets well before 2020, especially if ART eligibility is expanded—and that other countries could do the same.

"This is significant work as it provides further evidence that the UNAIDS 90-90-90 target is both realistic and achievable," said UNAIDS Executive Director Michel Sidibé, who was not involved in the study.

Lead author of the study was Tendani Gaolathe of the Botswana Harvard AIDS Institute Partnership. Other Harvard Chan School authors of the study included Kathleen Wirth, Molly Pretorius Holme, Joseph Makhema, Quanhong Lei, Vlad Novitsky, Kathleen Powis, Nealia Khan, Hermann Bussmann, Scott Dryden-Peterson, Rui Wang, Eric Tchetgen Tchetgen, Victor DeGruttola, and Shahin Lockman.

Funding came from The United States President's Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention under the terms of cooperative agreement U01 GH000447.

Explore further: HIV/AIDS long-term costs high—and unaffordable to most-affected countries

More information: "Botswana's Progress Toward Achieving the 2020 UNAIDS 90-90-90 Antiretroviral Treatment and Virologic Suppression Goals: Results of a Population-Based Survey," Tendani Gaolathe, Kathleen E. Wirth, Molly Pretorius Holme, Joseph Makhema, Sikhulile Moyo, Unoda Chakalisa, Etienne Kadima Yankinda, Quanhong Lei, Mompati Mmalane, Vlad Novitsky, Lillian Okui, Erik van Widenfelt, Kathleen M. Powis, Nealia Khan, Kara Bennett, Hermann Bussmann, Scott Dryden-Peterson, Refeletswe Lebelonyane, Shenaaz el-Halabi, Lisa A. Mills, Tafireyi Marukutira, Rui Wang, Eric J. Tchetgen Tchetgen, Victor DeGruttola, M. Essex, Shahin Lockman, and the BCPP study team, Lancet HIV, March 23, 2016, DOI: 10.1016/S2352-3018(16)00037-0

Related Stories

HIV/AIDS long-term costs high—and unaffordable to most-affected countries

March 7, 2016
There will be a significant shortfall in the funding needed for HIV control in sub-Saharan Africa in the coming years and those countries with the highest HIV burden will be unable to meet their obligations on their own to ...

High viral load in HIV-infected individuals underlies innate immune cell dysfunction

March 17, 2016
Individuals infected with HIV exhibit both severe immune deficiency and aberrant inflammation, resulting in susceptibility to secondary infection as the disease progresses. HIV-associated deficiencies in adaptive immune responses ...

New research reveals millions of those infected with HIV have never been diagnosed due to the fear of being tested

November 17, 2015
Academics from Royal Holloway, University of London, have carried out the largest global review of psychological barriers behind HIV testing and the factors that may influence people's decision to be tested. 

Study shows direct link between state spending habits and AIDS deaths

February 3, 2016
Despite considerable advances in the prevention and treatment of HIV/AIDS over the past 30 years, HIV infection rates have remained stagnant in the United States for the past decade. A study by researchers at the Yale Global ...

HIV transmission at each step of the care continuum in the United States

February 23, 2015
Individuals infected but undiagnosed with the human immunodeficiency virus (HIV) and those individuals diagnosed with HIV but not yet in medical care accounted for more than 90 percent of the estimated 45,000 HIV transmissions ...

HIV treatment while incarcerated helped prisoners achieve viral suppression

March 31, 2014
Treating inmates for the human immunodeficiency virus (HIV) while they were incarcerated in Connecticut helped a majority of them achieve viral suppression by the time they were released.

Recommended for you

Scientists divulge latest in HIV prevention

July 25, 2017
A far cry from the 1990s "ABC" campaign promoting abstinence and monogamy as HIV protection, scientists reported on new approaches Tuesday allowing people to have all the safe sex they want.

Girl's HIV infection seems under control without AIDS drugs

July 24, 2017
A South African girl born with the AIDS virus has kept her infection suppressed for more than eight years after stopping anti-HIV medicines—more evidence that early treatment can occasionally cause a long remission that, ...

Meds by monthly injection might revolutionize HIV care (Update)

July 24, 2017
Getting a shot of medication to control HIV every month or two instead of having to take pills every day could transform the way the virus is kept at bay.

Candidate AIDS vaccine passes early test

July 24, 2017
The three-decade-old quest for an AIDS vaccine received a shot of hope Monday when developers announced that a prototype triggered the immune system in an early phase of human trials.

Paris spotlight on latest in AIDS science

July 21, 2017
Some 6,000 HIV experts gather in Paris from Sunday to report advances in AIDS science as fading hopes of finding a cure push research into new fields.

Scientists elicit broadly neutralizing antibodies to HIV in calves

July 20, 2017
Scientists supported by the National Institutes of Health have achieved a significant step forward, eliciting broadly neutralizing antibodies (bNAbs) to HIV by immunizing calves. The findings offer insights for HIV vaccine ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.