Short Communication Parallel evolutions of the growth rate of newly diagnosed HIV cases and the proportion of potentially infective patients in Cayenne French Guiana: Should HAART be used to curb the epidemic? M. Nacher a, b, c, d, * , V. Vantilcke c , F. Huber e , M. El Guedj c , T. Vaz c , C. Magnien c , F. Djossou f , A. Mahamat f , F. Dabis g , P. Couppie ´ e a COREVIH Guyane, Cayenne General Hospital, Cayenne, French Guiana b Centre d’Investigation Clinique-Epide´miologie Clinique Antilles Guyane, Cayenne General Hospital, Cayenne, CIC EC 802, French Guiana c Day Hospital, Cayenne General Hospital, Cayenne, French Guiana d Equipe EA 3593, Universite´ Antilles Guyane, Cayenne, French Guiana e Department of Dermatology, Cayenne General Hospital, Cayenne, French Guiana f Department of Infectious Diseases, Cayenne General Hospital, Cayenne, French Guiana g Unite´ INSERM 593, Universite´ Victor Segalen Bordeaux 2, Bordeaux, Cedex, France article info Article history: Received 24 July 2008 Received in revised form 30 March 2009 Accepted 15 June 2009 Available online 18 August 2009 The prevention of new cases of human immunodeficiency virus (HIV) infection is one of the greatest health challenges today. Recently, increased access to highly active antiretroviral therapy (HAART) has been proposed as a method to curb the growth of the HIV epidemic. 1 Although the correlation between plasma viral load and semen or vaginal secretions is moderate, patients with a plasma viral load below 1500 copies/ml are considered to be low risk for transmitting the virus sexually. 2 This has been re-empha- sized recently following studies in Switzerland which showed that patients on effective HAART are sexually non-infectious. 3 This report presents data from French Guiana which support the view that HAART may have great potential for curbing the epidemic by keeping a large proportion of patients (treated or untreated) under the infective threshold of 1500 copies/ml. The HIV epidemic in French Guiana has been evolving since 1979. The estimated prevalence is now stable at approximately 1% and HIV-related deaths are slowly declining. Since late 2003, HIV mandatory reporting has led to the estimate that 16% of newly- diagnosed adults were recently infected (<6 months). 4 Trans- mission is mainly heterosexual. Late testing remains an important problem, notably in men and migrants. 5 Since 1992, there has been no significant change in the proportion of patients detected below 200 CD4. All patients have had access to free HAART since 1996 and a Western standard of care. Migrants represent 80% of patients, and their HIV-positive status gives them access to residence and work permits. The intense stigma and discrimination associated with HIV and widespread poverty favouring frequent transactional sex has resulted in at least 16% of patients living in couples reporting that they have not disclosed their HIV status to their partner. 6 A large proportion of patients do not use condoms consistently (20% in most communities and 50% in the Haitian community, 5 which represents half of the HIV patients followed). Socio-economic and cultural factors shape a high-risk sexual network with frequent concurrent partnerships, wide age differences between male and female partners, and economic dependence. Since 1992, clinical and biological data from all patients followed in Cayenne General Hospital have been entered into a database by trained technicians. These data were used in two ways to estimate the growth rate of the epidemic. First, the number of new patients diagnosed for a given year was divided by the cumulative number of patients from the previous year. Second, the number of new HIV diagnoses with CD4 counts >500 at entry was divided by the number of patients followed in the clinic during the previous year (excluding the deceased and those lost to follow-up) (assuming that most patients diagnosed with CD4 >500 were recently infected). The annual proportion of patients (treated and untreated) with a viral load below 1500 copies/ml was also calculated. Spearman’s rank correlation was used to determine the relationship between the growth rate of the epidemic and the proportion of potentially sexually infective patients in care. Fig. 1 shows the progressive decline of the surrogate for the epidemic’s growth rate in Cayenne and its surroundings, and its relationship with the proportion of potentially infectious patients (viral load >1500 copies/ml). It also shows a rapid decline in the number of potentially sexually infective patients associated with the introduction of HAART, and the progressive increase in the * Corresponding author. COREVIH, Cayenne General Hospital, 97300 Cayenne, French Guiana. Tel.: þ594 594 39 50 24; fax: þ594 594 39 50 02. E-mail address: mathieu.nacher@ch-cayenne.fr (M. Nacher). Contents lists available at ScienceDirect Public Health journal homepage: www.elsevierhealth.com/journals/pubh 0033-3506/$ – see front matter Ó 2009 Published by Elsevier Ltd on behalf of The Royal Society for Public Health. doi:10.1016/j.puhe.2009.06.007 Public Health 123 (2009) 573–574