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Pitfalls of WHO TasP recommendations for discordant couples
A study conducted in Côte d’Ivoire has revealed that the World Health Organisation (WHO) 2013 antiretroviral (ARV) treatment recommendations regarding serodiscordant couples (when one person is HIV-positive and the other HIV-negative) may only benefit a small number of people. The WHO’s Consolidated ARV Guidelines 2013 state “Partners with HIV in serodiscordant couples should be offered ART to reduce HIV transmission to uninfected partners.” Researchers set out to assess how many people living with HIV (PLHIV) would benefit from this based on their relationship status and the HIV status of their partner.
The use of ARV treatment to reduce the risk of onward HIV transmission is known as treatment as prevention (TasP). The idea behind TasP is to use treatment as a prevention strategy to enable individuals to protect their sexual partners, or, on a large scale, reduce HIV transmission among a population. An individual may choose to begin treatment earlier, if they are given the option, to help prevent sexual transmission of HIV to their partner – this should form part of a combination approach to prevention.
In the Côte d’Ivoire study around half of the cohort who were not on treatment had CD4 counts of above 500 cells/mm3; the recommended initiation point for treatment. Based on their relationship status these individuals could have been eligible for early treatment to protect their partners according to the 2013 guidelines. However, it was found that only 12 percent were in fact eligible as 30 percent were not in a stable sexual partnership, 24 percent were in a relationship with an HIV-positive partner and 34 percent were in a stable sexual partnership but they did not know their partner’s status. A stable sexual partnership with a known HIV-negative partner is required to be eligible for TasP.
This gap highlights the need to improve promotion and availability of couples testing and to support disclosure of status among couples to ensure they can take full advantage of TasP, in settings where it is available, to protect their health.