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Obeng BM, Kelleher AD, Di Giallonardo F. Molecular epidemiology to aid virtual elimination of HIV transmission in Australia. Virus Res 2024; 341:199310. [PMID: 38185332 PMCID: PMC10825322 DOI: 10.1016/j.virusres.2024.199310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/09/2024]
Abstract
The Global UNAIDS 95/95/95 targets aim to increase the percentage of persons who know their HIV status, receive antiretroviral therapy, and have achieved viral suppression. Achieving these targets requires efforts to improve the public health response to increase access to care for those living with HIV, identify those yet undiagnosed with HIV early, and increase access to prevention for those most at risk of HIV acquisition. HIV infections in Australia are among the lowest globally having recorded significant declines in new diagnoses in the last decade. However, the HIV epidemic has changed with an increasing proportion of newly diagnosed infections among those born outside Australia observed in the last five years. Thus, the current prevention efforts are not enough to achieve the UNAIDS targets and virtual elimination across all population groups. We believe both are possible by including molecular epidemiology in the public health response. Molecular epidemiology methods have been crucial in the field of HIV prevention, particularly in demonstrating the efficacy of treatment as prevention. Cluster detection using molecular epidemiology can provide opportunities for the real-time detection of new outbreaks before they grow, and cluster detection programs are now part of the public health response in the USA and Canada. Here, we review what molecular epidemiology has taught us about HIV evolution and spread. We summarize how we can use this knowledge to improve public health measures by presenting case studies from the USA and Canada. We discuss the successes and challenges of current public health programs in Australia, and how we could use cluster detection as an add-on to identify gaps in current prevention measures easier and respond quicker to growing clusters. Lastly, we raise important ethical and legal challenges that need to be addressed when HIV genotypic data is used in combination with personal data.
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Affiliation(s)
- Billal M Obeng
- The Kirby Institute, University of New South Wales, Sydney, Australia
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2
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Yufenyuy EL, Detorio M, Dobbs T, Patel HK, Jackson K, Vedapuri S, Parekh BS. Performance evaluation of the Asante Rapid Recency Assay for verification of HIV diagnosis and detection of recent HIV-1 infections: Implications for epidemic control. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000316. [PMID: 36962217 PMCID: PMC10021762 DOI: 10.1371/journal.pgph.0000316] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 03/09/2022] [Indexed: 11/18/2022]
Abstract
We previously described development of a rapid test for recent infection (RTRI) that can diagnose HIV infection and detect HIV-1 recent infections in a single device. This technology was transferred to a commercial partner as Asante Rapid Recency Assay (ARRA). We evaluated performance of the ARRA kits in the laboratory using a well-characterized panel of specimens. The plasma specimen panel (N = 1500) included HIV-1 (N = 570), HIV-2 (N = 10), and HIV-negatives (N = 920) representing multiple subtypes and geographic locations. Reference diagnostic data were generated using the Bio-Rad HIV-1-2-O EIA/Western blot algorithm with further serotyping performed using the Multispot HIV-1/2 assay. The LAg-Avidity EIA was used to generate reference data on recent and long-term infection for HIV-1 positive specimens at a normalized optical density (ODn) cutoff of 2.0 corresponding to a mean duration of about 6 months. All specimens were tested with ARRA according to the manufacturer's recommendations. Test strips were also read for line intensities using a reader and results were correlated with visual interpretation. ARRA's positive verification line (PVL) correctly classified 575 of 580 HIV-positive and 910 of 920 negative specimens resulting in a sensitivity of 99.1% (95% CI: 98.0-99.6) and specificity of 98.9% (95% CI: 98.1-99.4), respectively. The reader-based classification was similar for PVL with sensitivity of 99.3% (576/580) and specificity of 98.8% (909/920). ARRA's long-term line (LTL) classified 109 of 565 HIV-1 specimens as recent and 456 as long-term compared to 98 as recent and 467 as long-term (LT) by LAg-Avidity EIA (cutoff ODn = 2.0), suggesting a mean duration of recent infection (MDRI) close to 6 months. Agreement of ARRA with LAg recent cases was 81.6% (80/98) and LT cases was 93.8% (438/467), with an overall agreement of 91.7% (kappa = 0.72). The reader (cutoff 2.9) classified 109/566 specimens as recent infections compared to 99 by the LAg-Avidity EIA for recency agreement of 81.8% (81/99), LT agreement of 9% (439/467) with overall agreement of 91.9% (kappa = 0.72). The agreement between visual interpretation and strip reader was 99.9% (95% CI: 99.6-99.9) for the PVL and 98.1% (95% CI: 96.6-98.9) for the LTL. ARRA performed well with HIV diagnostic sensitivity >99% and specificity >98%. Its ability to identify recent infections is comparable to the LA-Avidity EIA corresponding to an MDRI of about 6 months. This point-of-care assay has implications for real-time surveillance of new infections among newly diagnosed individuals for targeted prevention and interrupting ongoing transmission thus accelerating epidemic control.
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Affiliation(s)
- Ernest L Yufenyuy
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mervi Detorio
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Trudy Dobbs
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Hetal K Patel
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Keisha Jackson
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Shanmugam Vedapuri
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Bharat S Parekh
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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3
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Burns JE, Stöhr W, Kinloch-De Loes S, Fox J, Clarke A, Nelson M, Thornhill J, Babiker A, Frater J, Pett SL, Fidler S. Tolerability of four-drug antiretroviral combination therapy in primary HIV-1 infection. HIV Med 2021; 22:770-774. [PMID: 33964099 PMCID: PMC8612356 DOI: 10.1111/hiv.13118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2021] [Indexed: 11/30/2022]
Abstract
Objectives Rapid initiation of antiretroviral therapy (ART) is important for individuals with high baseline viral loads, such as in primary HIV‐1 infection (PHI). Four‐drug regimens are sometimes considered; however, data are lacking on tolerability. We aimed to evaluate the tolerability of four‐drug regimens used in the Research in Viral Eradication of HIV‐1 Reservoirs (RIVER) study. Methods At enrolment, ART‐naïve adult participants or those newly commenced on ART were initiated or intensified to four‐drug regimens within 4 weeks of PHI. Rapid start was defined as pre‐confirmation or ≤ 7 days of confirmed diagnosis. Primary and secondary outcomes were patient‐reported adherence measured by 7‐day recall and regimen switches between enrolment and randomization, respectively. Results Overall, 54 men were included: 72.2% were of white ethnicity, with a median age of 32 years old, 42.6% had a viral load of ≥ 100 000 HIV‐1 RNA copies/mL, and in 92.6% sex with men was the mode of acquisition of HIV‐1. Twenty (37%) started a four‐drug regimen and 34 (63%) were intensified. Rapid ART initiation occurred in 28%, 100% started in ≤ 4 weeks. By weeks 4, 12, and 24, 37.0%, 69.0%, and 94.0% were undetectable (viral load < 50 copies/mL), respectively. Adherence rates of 100% at weeks 4, 12, 22 and 24 were reported in 88.9%, 87.0%, 82.4% and 94.1% of participants, respectively. Five individuals switched to three drugs, four changed their regimen constituents, and two switched post‐randomization. Conclusions Overall, four‐drug regimens were well tolerated and had high levels of adherence. Whilst their benefit over three‐drug regimens is lacking, our findings should provide reassurance if a temporarily intensified regimen is clinically indicated to help facilitate treatment.
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Affiliation(s)
- J E Burns
- Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, UK
| | - W Stöhr
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - S Kinloch-De Loes
- Department of Infection and Immunity, Royal Free Hospital, London, UK.,Institute of Immunity & Transplantation, University College London, London, UK
| | - J Fox
- Department of Genitourinary Medicine and Infectious Diseases, Guys and St, Thomas' NHS Trust, London, UK.,Department of Genitourinary Medicine and Infectious Diseases, NIHR Biomedical Research Centre, King's College London, London, UK
| | - A Clarke
- Elton John Centre, Brighton, UK.,Department of HIV and Sexual Health, Sussex University Hospital, Brighton, UK.,Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - M Nelson
- Department of HIV Medicine, Chelsea and Westminster Hospital, Imperial College London, London, UK
| | - J Thornhill
- Department of Infectious Disease, Imperial College London, London, UK.,NIHR Imperial Biomedical Research Centre, London, UK
| | - A Babiker
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - J Frater
- Nuffield Department of Medicine, Oxford University, Oxford, UK.,Nuffield Department of Medicine, Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - S L Pett
- Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, UK.,Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - S Fidler
- Department of Infectious Disease, Imperial College London, London, UK.,NIHR Imperial Biomedical Research Centre, London, UK
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Cassell MM, Wilcher R, Ramautarsing RA, Phanuphak N, Mastro TD. Go Where the Virus Is: An HIV Micro-epidemic Control Approach to Stop HIV Transmission. GLOBAL HEALTH: SCIENCE AND PRACTICE 2020; 8:614-625. [PMID: 33361230 PMCID: PMC7784070 DOI: 10.9745/ghsp-d-19-00418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 09/29/2020] [Indexed: 11/15/2022]
Abstract
Essentially all HIV transmission is from people living with HIV who are not virally suppressed. An HIV micro-epidemic control approach that differentiates treatment support and prevention services for people living with HIV and their network members according to viral burden could optimize the impact of epidemic control efforts.
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Affiliation(s)
| | | | | | - Nittaya Phanuphak
- Institute of HIV Research and Innovation, Bangkok, Thailand.,Center of Excellence in Transgender Health, Chulalongkorn University, Bangkok, Thailand
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Lopez-Rios J, Frasca T, Kindlon MJ, Exner TM, Norcini Pala A, Wainberg ML, Calderon Y, Cotroneo R, Jiménez AA, Remien RH. Limited Knowledge and Lack of Screening for Acute HIV Infection at Primary Care Clinics in High-Prevalence Communities of New York City. AIDS Behav 2019; 23:2870-2878. [PMID: 31054030 DOI: 10.1007/s10461-019-02527-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Diagnosis and treatment of acute HIV infection (AHI) is crucial for ending the HIV epidemic. Individuals with AHI, who have high viral loads and often are unaware of their infection, are more likely to transmit HIV to others than those with chronic infection. In preparation for an educational intervention on AHI in primary health care settings in high HIV-prevalence areas of New York City, 22 clinic directors, 313 clinic providers, and 220 patients were surveyed on their knowledge and awareness of the topic from 2012-2015. Basic HIV knowledge was high among all groups while knowledge of AHI was partial among providers and virtually absent among patients. Inadequate knowledge about this crucial phase of HIV may be impeding timely identification of cases in the primary care setting.
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Affiliation(s)
- Javier Lopez-Rios
- HIV Center for Clinical & Behavioral Studies, New York State Psychiatric Institute/Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA.
| | - Timothy Frasca
- HIV Center for Clinical & Behavioral Studies, New York State Psychiatric Institute/Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Marcia J Kindlon
- New York State Department of Health, AIDS Institute, Albany, NY, USA
| | - Theresa M Exner
- HIV Center for Clinical & Behavioral Studies, New York State Psychiatric Institute/Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Andrea Norcini Pala
- HIV Center for Clinical & Behavioral Studies, New York State Psychiatric Institute/Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Milton L Wainberg
- HIV Center for Clinical & Behavioral Studies, New York State Psychiatric Institute/Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Yvette Calderon
- Department of Emergency Medicine, Icahn School of Medicine, Mount Sinai Beth Israel, New York, NY, USA
| | - Richard Cotroneo
- New York State Department of Health, AIDS Institute, Albany, NY, USA
| | | | - Robert H Remien
- HIV Center for Clinical & Behavioral Studies, New York State Psychiatric Institute/Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
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Di Giallonardo F, Pinto AN, Keen P, Shaik A, Carrera A, Salem H, Telfer B, Cooper C, Price K, Selvey C, Holden J, Bachmann N, Lee FJ, Dwyer DE, Duchêne S, Holmes EC, Grulich AE, Kelleher AD. Limited Sustained Local Transmission of HIV-1 CRF01_AE in New South Wales, Australia. Viruses 2019; 11:v11050482. [PMID: 31137836 PMCID: PMC6563510 DOI: 10.3390/v11050482] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/21/2019] [Accepted: 05/24/2019] [Indexed: 02/06/2023] Open
Abstract
Australia’s response to the human immunodeficiency virus type 1 (HIV-1) pandemic led to effective control of HIV transmission and one of the world’s lowest HIV incidence rates—0.14%. Although there has been a recent decline in new HIV diagnoses in New South Wales (NSW), the most populous state in Australia, there has been a concomitant increase with non-B subtype infections, particularly for the HIV-1 circulating recombinant form CRF01_AE. This aforementioned CRF01_AE sampled in NSW, were combined with those sampled globally to identify NSW-specific viral clades. The population growth of these clades was assessed in two-year period intervals from 2009 to 2017. Overall, 109 NSW-specific clades were identified, most comprising pairs of sequences; however, five large clades comprising ≥10 sequences were also found. Forty-four clades grew over time with one or two sequences added to each in different two-year periods. Importantly, while 10 of these clades have seemingly discontinued, the remaining 34 were still active in 2016/2017. Seven such clades each comprised ≥10 sequences, and are representative of individual sub-epidemics in NSW. Thus, although the majority of new CRF01_AE infections were associated with small clades that rarely establish ongoing chains of local transmission, individual sub-epidemics are present and should be closely monitored.
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Affiliation(s)
- Francesca Di Giallonardo
- The Kirby Institute, The University of New South Wales, Sydney, New South Wales 2052, Australia.
| | - Angie N Pinto
- The Kirby Institute, The University of New South Wales, Sydney, New South Wales 2052, Australia.
- Department of Infectious Diseases & Microbiology, Royal Prince Alfred Hospital, Camperdown, New South Wales 2050, Australia.
| | - Phillip Keen
- The Kirby Institute, The University of New South Wales, Sydney, New South Wales 2052, Australia.
| | - Ansari Shaik
- The Kirby Institute, The University of New South Wales, Sydney, New South Wales 2052, Australia.
| | - Alex Carrera
- New South Wales State Reference Laboratory for HIV/AIDS, Darlinghurst, New South Wales 2010, Australia.
| | - Hanan Salem
- New South Wales Health Pathology, Royal Prince Alfred Hospital, Camperdown, New South Wales 2050, Australia.
| | - Barbara Telfer
- Health Protection New South Wales, New South Wales Health, NSW, North Sydne, New South Wales 2060, Australia.
| | - Craig Cooper
- Positive Life New South Wales, Surry Hills, New South Wales 2010, Australia.
| | - Karen Price
- ACON Health Ltd., Surry Hills, New South Wales 2010, Australia.
| | - Christine Selvey
- Health Protection New South Wales, New South Wales Health, NSW, North Sydne, New South Wales 2060, Australia.
| | - Joanne Holden
- Centre for Population Health, New South Wales Ministry of Health, North Sydney, New South Wales 2059, Australia.
| | - Nadine Bachmann
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Institute of Medical Virology, University of Zurich, 8091 Zurich, Switzerland.
| | - Frederick J Lee
- New South Wales Health Pathology, Royal Prince Alfred Hospital, Camperdown, New South Wales 2050, Australia.
- Department of Clinical Immunology & Allergy, Royal Prince Alfred Hospital, Camperdown, New South Wales 2050, Australia.
- Sydney Medical School, University of Sydney, Sydney, New South Wales 2006, Australia.
| | - Dominic E Dwyer
- New South Wales Health Pathology-Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, New South Wales 2145, Australia.
| | - Sebastián Duchêne
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria 3000, Australia.
| | - Edward C Holmes
- Sydney Medical School, University of Sydney, Sydney, New South Wales 2006, Australia.
- Marie Bashir Institute for Infectious Diseases and Biosecurity, Charles Perkins Centre, School of Life and Environmental Sciences, The University of Sydney, Sydney, New South Wales 2006, Australia.
| | - Andrew E Grulich
- The Kirby Institute, The University of New South Wales, Sydney, New South Wales 2052, Australia.
| | - Anthony D Kelleher
- The Kirby Institute, The University of New South Wales, Sydney, New South Wales 2052, Australia.
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Dimitrov D, Wood D, Ulrich A, Swan DA, Adamson B, Lama JR, Sanchez J, Duerr A. Projected effectiveness of HIV detection during early infection and rapid ART initiation among MSM and transgender women in Peru: A modeling study. Infect Dis Model 2019; 4:73-82. [PMID: 31025025 PMCID: PMC6475714 DOI: 10.1016/j.idm.2019.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 04/01/2019] [Accepted: 04/03/2019] [Indexed: 12/01/2022] Open
Abstract
Background The Sabes study, a treatment as prevention intervention in Peru, tested the hypothesis that initiating antiretroviral therapy (ART) early in HIV infection when viral load is high, would markedly reduce onward HIV transmission among high-risk men who have sex with men (MSM) and transgender women (TW). We investigated the potential population-level benefits of detection of HIV early after acquisition and rapid initiation of ART. Methods We designed a transmission dynamic model to simulate the HIV epidemic among MSM and TW in Peru, calibrated to data on HIV prevalence and ART coverage from 2004 to 2011. We assessed the impact of an intervention starting in 2018 in which up to 50% of the new infections were diagnosed within three months of acquisition and initiated on ART within 1 month of diagnosis. We estimated the impact of the intervention over 20 years using the cumulative prevented fraction of new HIV infections compared to scenarios without intervention. Findings Our model suggests that only 19% of the infected MSM and TW are virally suppressed in 2018 and 35%-40% of the new HIV infections are transmitted from contacts with acutely-infected partners. An intervention reaching 10% of all acutely infected MSM and TW is projected to prevent 13.3% [Uncertainty interval: 11.9%-14.3%] of the new infections over 20 years and reduce HIV incidence in 2038 by 24%. Reaching 50% of all acutely infected MSM and TW will increase the prevalence of viral suppression in 2038 to 59% and prevent 41% of expected infections over 20 years. Reaching 50% of the high-risk MSM and TW in acute phase would reduce HIV incidence in 2038 by 60% and prevent 36% of new infections between 2018 and 2038. Conclusions Early detection of HIV infections and rapid initiation of ART among MSM is desirable as it would increase the effectiveness of the HIV prevention program in Peru. Targeting high-risk MSM and TW will be highly efficient.
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Affiliation(s)
- Dobromir Dimitrov
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Daniel Wood
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Angela Ulrich
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
| | - David A Swan
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Blythe Adamson
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Comparative Health Outcomes, Policy, & Economics (CHOICE) Institute, University of Washington, Seattle, WA, USA
| | - Javier R Lama
- Asociación Civil Impacta Salud y Educación, Lima, Peru
| | - Jorge Sanchez
- Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Universidad Mayor de San Marcos, Lima, Peru
| | - Ann Duerr
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
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Pinto AN, Hawke K, Castley A, Chibo D, Giallonardo FD, Cooper C, Sawleshwarkar S, Kelleher A, Dwyer DE. HIV-1 subtype diversity, transmitted drug resistance and phylogenetics in Australia. Future Virol 2018. [DOI: 10.2217/fvl-2018-0031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Australia has maintained a low prevalence of HIV, with a mainly concentrated epidemic and successful public health response. With the widespread availability of HIV genotyping for resistance testing, and development of phylogenetic methodologies, the field of molecular epidemiology has evolved a deeper understanding of diversity and transmission dynamics of HIV. Studies combining HIV genotype with epidemiological data have allowed insights to be gained into the changing subtype diversity, rates of transmitted drug resistance and transmission networks of HIV in Australia. This review provides an overview of HIV molecular epidemiology studies in Australia.
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Affiliation(s)
- Angie N Pinto
- The Kirby Institute, The University of New South Wales, UNSW Sydney, Australia
| | - Karen Hawke
- South Australian Health & Medical Research Institute, Adelaide, South Australia
| | - Allison Castley
- PathWest, Clinical Immunology, Department of Health, Murdoch, Western Australia, Australia
| | - Doris Chibo
- HIV Characterization Laboratory, Victorian Infectious Diseases Reference Laboratory, Doherty Institute, Melbourne, Victoria, Australia
| | | | - Craig Cooper
- Positive Life NSW, Sydney, New South Wales, Australia
| | - Shailendra Sawleshwarkar
- The University of Sydney, Faculty of Medicine & Health, Westmead Clinical School, Western Sydney Sexual Health Centre, Parramatta, New South Wales, Australia
| | - Anthony Kelleher
- The Kirby Institute, The University of New South Wales, UNSW Sydney, Australia
| | - Dominic E Dwyer
- NSWHP-ICPMR, Westmead Hospital, Westmead, NSW, Australia
- Westmead Clinical School, University of Sydney, Westmead, Australia
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Abstract
Human immunodeficiency virus (HIV) infection continues to disproportionately affect vulnerable populations in Canada; particularly men who have sex with men (MSM). Novel HIV prevention strategies have recently expanded from the use of non-occupational post-exposure prophylaxis (nPEP) after high risk exposures to the use of pre-exposure prophylaxis (PrEP) in which individuals reduce risk of HIV infection through use of combination antiretrovirals taken prior to risk exposure. With approval of tenofovir/emtricitabine (TDF/FTC) for use as PrEP only in early 2016, and with limited public funding to date, uptake in Canada is in its preliminary stages. These biomedical prevention strategies have proven efficacy for MSM, and they may have potential for other at-risk populations. With generic formulations of TDF/FTC now available in Canada, there is an opportunity for widespread implementation. Expanding knowledge of health care providers across Canada on how best to assess, refer for or prescribe and monitor PrEP will contribute to the current efforts to reach the global goal of eliminating new HIV infections.
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Miller JC, Slim AC. Saturation effects and the concurrency hypothesis: Insights from an analytic model. PLoS One 2017; 12:e0187938. [PMID: 29136021 PMCID: PMC5685581 DOI: 10.1371/journal.pone.0187938] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 10/27/2017] [Indexed: 01/06/2023] Open
Abstract
Sexual partnerships that overlap in time (concurrent relationships) may play a significant role in the HIV epidemic, but the precise effect is unclear. We derive edge-based compartmental models of disease spread in idealized dynamic populations with and without concurrency to allow for an investigation of its effects. Our models assume that partnerships change in time and individuals enter and leave the at-risk population. Infected individuals transmit at a constant per-partnership rate to their susceptible partners. In our idealized populations we find regions of parameter space where the existence of concurrent partnerships leads to substantially faster growth and higher equilibrium levels, but also regions in which the existence of concurrent partnerships has very little impact on the growth or the equilibrium. Additionally we find mixed regimes in which concurrency significantly increases the early growth, but has little effect on the ultimate equilibrium level. Guided by model predictions, we discuss general conditions under which concurrent relationships would be expected to have large or small effects in real-world settings. Our observation that the impact of concurrency saturates suggests that concurrency-reducing interventions may be most effective in populations with low to moderate concurrency.
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Affiliation(s)
- Joel C. Miller
- Institute for Disease Modeling, Bellevue, WA, United States of America
- * E-mail:
| | - Anja C. Slim
- School of Mathematical Sciences, Monash University, Clayton, VIC, Australia
- School of Earth, Atmosphere, and the Environment, Monash University, Clayton, VIC, Australia
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11
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Rutstein SE, Ananworanich J, Fidler S, Johnson C, Sanders EJ, Sued O, Saez-Cirion A, Pilcher CD, Fraser C, Cohen MS, Vitoria M, Doherty M, Tucker JD. Clinical and public health implications of acute and early HIV detection and treatment: a scoping review. J Int AIDS Soc 2017; 20:21579. [PMID: 28691435 PMCID: PMC5515019 DOI: 10.7448/ias.20.1.21579] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 05/29/2017] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION The unchanged global HIV incidence may be related to ignoring acute HIV infection (AHI). This scoping review examines diagnostic, clinical, and public health implications of identifying and treating persons with AHI. METHODS We searched PubMed, in addition to hand-review of key journals identifying research pertaining to AHI detection and treatment. We focused on the relative contribution of AHI to transmission and the diagnostic, clinical, and public health implications. We prioritized research from low- and middle-income countries (LMICs) published in the last fifteen years. RESULTS AND DISCUSSION Extensive AHI research and limited routine AHI detection and treatment have begun in LMIC. Diagnostic challenges include ease-of-use, suitability for application and distribution in LMIC, and throughput for high-volume testing. Risk score algorithms have been used in LMIC to screen for AHI among individuals with behavioural and clinical characteristics more often associated with AHI. However, algorithms have not been implemented outside research settings. From a clinical perspective, there are substantial immunological and virological benefits to identifying and treating persons with AHI - evading the irreversible damage to host immune systems and seeding of viral reservoirs that occurs during untreated acute infection. The therapeutic benefits require rapid initiation of antiretrovirals, a logistical challenge in the absence of point-of-care testing. From a public health perspective, AHI diagnosis and treatment is critical to: decrease transmission via viral load reduction and behavioural interventions; improve pre-exposure prophylaxis outcomes by avoiding treatment initiation for HIV-seronegative persons with AHI; and, enhance partner services via notification for persons recently exposed or likely transmitting. CONCLUSIONS There are undeniable clinical and public health benefits to AHI detection and treatment, but also substantial diagnostic and logistical barriers to implementation and scale-up. Effective early ART initiation may be critical for HIV eradication efforts, but widespread use in LMIC requires simple and accurate diagnostic tools. Implementation research is critical to facilitate sustainable integration of AHI detection and treatment into existing health systems and will be essential for prospective evaluation of testing algorithms, point-of-care diagnostics, and efficacious and effective first-line regimens.
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Affiliation(s)
- Sarah E. Rutstein
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jintanat Ananworanich
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Sarah Fidler
- Department of Medicine, Imperial College London, London, UK
| | - Cheryl Johnson
- HIV Department, World Health Organization, Geneva, Switzerland
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Eduard J. Sanders
- Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Omar Sued
- Fundación Huésped, Buenos Aires, Argentina
| | - Asier Saez-Cirion
- Institut Pasteur, HIV Inflammation and Persistance Unit, Paris, France
| | | | - Christophe Fraser
- Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Myron S. Cohen
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marco Vitoria
- HIV Department, World Health Organization, Geneva, Switzerland
| | - Meg Doherty
- HIV Department, World Health Organization, Geneva, Switzerland
| | - Joseph D. Tucker
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- UNC Project-China, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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12
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Phylogenetic Investigation of a Statewide HIV-1 Epidemic Reveals Ongoing and Active Transmission Networks Among Men Who Have Sex With Men. J Acquir Immune Defic Syndr 2016; 70:428-35. [PMID: 26258569 DOI: 10.1097/qai.0000000000000786] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Molecular epidemiological evaluation of HIV-1 transmission networks can elucidate behavioral components of transmission that can be targets for intervention. METHODS We combined phylogenetic and statistical approaches using pol sequences from patients diagnosed between 2004 and 2011 at a large HIV center in Rhode Island, following 75% of the state's HIV population. Phylogenetic trees were constructed using maximum likelihood, and putative transmission clusters were evaluated using latent class analyses to determine association of cluster size with underlying demographic/behavioral characteristics. A logistic growth model was used to assess intracluster dynamics over time and predict "active" clusters that were more likely to harbor undiagnosed infections. RESULTS Of the 1166 HIV-1 subtype B sequences, 31% were distributed among 114 statistically supported, monophyletic clusters (range: 2-15 sequences/cluster). Sequences from men who have sex with men (MSM) formed 52% of clusters. Latent class analyses demonstrated that sequences from recently diagnosed (2008-2011) MSM with primary HIV infection (PHI) and other sexually transmitted infections (STIs) were more likely to form larger clusters (odds ratio: 1.62-11.25, P < 0.01). MSM in clusters were more likely to have anonymous partners and meet partners at sex clubs and pornographic stores. Four large clusters with 38 sequences (100% male, 89% MSM) had a high probability of harboring undiagnosed infections and included younger MSM with PHI and STIs. CONCLUSIONS In this first large-scale molecular epidemiological investigation of HIV-1 transmission in New England, sexual networks among recently diagnosed MSM with PHI and concomitant STIs contributed to the ongoing transmission. Characterization of transmission dynamics revealed actively growing clusters, which may be targets for intervention.
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Anogenital HIV RNA in Thai men who have sex with men in Bangkok during acute HIV infection and after randomization to standard vs. intensified antiretroviral regimens. J Int AIDS Soc 2015; 18:19470. [PMID: 25956171 PMCID: PMC4425809 DOI: 10.7448/ias.18.1.19470] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 03/31/2015] [Accepted: 04/13/2015] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION HIV transmission risk is highest during acute HIV infection (AHI). We evaluated HIV RNA in the anogenital compartment in men who have sex with men (MSM) during AHI and compared time to undetectable HIV RNA after three-drug versus five-drug antiretroviral therapy (ART) to understand risk for onward HIV transmission. METHODS MSM with AHI (n=54) had blood, seminal plasma and anal lavage collected for HIV RNA at baseline, days 3 and 7, and weeks 2, 4, 12 and 24. Data were compared between AHI stages: 1 (fourth-generation antigen-antibody combo immunoassay [IA]-, third-generation IA-, n=15), 2 (fourth-generation IA+, third-generation IA-, n=9) and 3 (fourth-generation IA+, third-generation IA+, western blot-/indeterminate, n=30) by randomization to five-drug (tenofovir+emtricitabine+efavirenz+raltegravir+maraviroc, n=18) versus three-drug (tenofovir+emtricitabine+efavirenz, n=18) regimens. RESULTS Mean age was 29 years and mean duration since HIV exposure was 15.4 days. Mean baseline HIV RNA was 5.5 in blood, 3.9 in seminal plasma and 2.6 log10 copies/ml in anal lavage (p<0.001). Blood and seminal plasma HIV RNA were higher in AHI Stage 3 compared to Stage 1 (p<0.01). Median time from ART initiation to HIV RNA <50 copies/ml was 60 days in blood, 15 days in seminal plasma and three days in anal lavage. Compared with the three-drug ART, the five-drug ART had a shorter time to HIV RNA <1500 copies/ml in blood (15 vs. 29 days, p=0.005) and <50 copies/ml in seminal plasma (13 vs. 24 days, p=0.048). CONCLUSIONS Among MSM with AHI, HIV RNA was highest in blood, followed by seminal plasma and anal lavage. ART rapidly reduced HIV RNA in all compartments, with regimen intensified by raltegravir and maraviroc showing faster HIV RNA reductions in blood and seminal plasma.
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14
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Crooks L, Kidd MR, Lake R, Wright EJ, Reis E. Standing at the crossroads in HIV management: implications for primary care practice from the AIDS 2014 conference. Med J Aust 2015; 201:440-1. [PMID: 25332021 DOI: 10.5694/mja14.01106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 09/25/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Levinia Crooks
- Australasian Society for HIV Medicine, Sydney, NSW, Australia.
| | - Michael R Kidd
- Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Robert Lake
- Australian Federation of AIDS Organisations, Sydney, NSW, Australia
| | | | - Edward Reis
- Australasian Society for HIV Medicine, Sydney, NSW, Australia
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15
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Impact of human immunodeficiency virus type-1 sequence diversity on antiretroviral therapy outcomes. Viruses 2014; 6:3855-72. [PMID: 25333465 PMCID: PMC4213566 DOI: 10.3390/v6103855] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 10/09/2014] [Accepted: 10/13/2014] [Indexed: 12/04/2022] Open
Abstract
Worldwide circulating HIV-1 genomes show extensive variation represented by different subtypes, polymorphisms and drug-resistant strains. Reports on the impact of sequence variation on antiretroviral therapy (ART) outcomes are mixed. In this review, we summarize relevant published data from both resource-rich and resource-limited countries in the last 10 years on the impact of HIV-1 sequence diversity on treatment outcomes. The prevalence of transmission of drug resistant mutations (DRMs) varies considerably, ranging from 0% to 27% worldwide. Factors such as geographic location, access and availability to ART, duration since inception of treatment programs, quality of care, risk-taking behaviors, mode of transmission, and viral subtype all dictate the prevalence in a particular geographical region. Although HIV-1 subtype may not be a good predictor of treatment outcome, review of emerging evidence supports the fact that HIV-1 genome sequence-resulting from natural polymorphisms or drug-associated mutations-matters when it comes to treatment outcomes. Therefore, continued surveillance of drug resistant variants in both treatment-naïve and treatment-experienced populations is needed to reduce the transmission of DRMs and to optimize the efficacy of the current ART armamentarium.
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16
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Atkinson SR. Time to end the ban on HIV-positive proceduralists and dentists. Med J Aust 2014; 201:384. [PMID: 25296057 DOI: 10.5694/mja14.01031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 08/25/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Sean R Atkinson
- Department of Sexual Health, Cairns Hospital, Cairns, QLD, Australia.
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17
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Friedman SR, Downing MJ, Smyrnov P, Nikolopoulos G, Schneider JA, Livak B, Magiorkinis G, Slobodianyk L, Vasylyeva TI, Paraskevis D, Psichogiou M, Sypsa V, Malliori MM, Hatzakis A. Socially-integrated transdisciplinary HIV prevention. AIDS Behav 2014; 18:1821-34. [PMID: 24165983 DOI: 10.1007/s10461-013-0643-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Current ideas about HIV prevention include a mixture of primarily biomedical interventions, socio-mechanical interventions such as sterile syringe and condom distribution, and behavioral interventions. This article presents a framework for socially-integrated transdisciplinary HIV prevention that may improve current prevention efforts. It first describes one socially-integrated transdisciplinary intervention project, the Transmission Reduction Intervention Project. We focus on how social aspects of the intervention integrate its component parts across disciplines and processes at different levels of analysis. We then present socially-integrated perspectives about how to improve combination antiretroviral treatment (cART) processes at the population level in order to solve the problems of the treatment cascade and make "treatment as prevention" more effective. Finally, we discuss some remaining problems and issues in such a social transdisciplinary intervention in the hope that other researchers and public health agents will develop additional socially-integrated interventions for HIV and other diseases.
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Affiliation(s)
- Samuel R Friedman
- Institute of Infectious Diseases Research, National Development and Research Institutes, Inc., 71 West 23rd Street, 8th Floor, New York, NY, 10010, USA,
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18
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Dennis AM, Herbeck JT, Brown AL, Kellam P, de Oliveira T, Pillay D, Fraser C, Cohen MS. Phylogenetic studies of transmission dynamics in generalized HIV epidemics: an essential tool where the burden is greatest? J Acquir Immune Defic Syndr 2014; 67:181-95. [PMID: 24977473 PMCID: PMC4304655 DOI: 10.1097/qai.0000000000000271] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Efficient and effective HIV prevention measures for generalized epidemics in sub-Saharan Africa have not yet been validated at the population level. Design and impact evaluation of such measures requires fine-scale understanding of local HIV transmission dynamics. The novel tools of HIV phylogenetics and molecular epidemiology may elucidate these transmission dynamics. Such methods have been incorporated into studies of concentrated HIV epidemics to identify proximate and determinant traits associated with ongoing transmission. However, applying similar phylogenetic analyses to generalized epidemics, including the design and evaluation of prevention trials, presents additional challenges. Here we review the scope of these methods and present examples of their use in concentrated epidemics in the context of prevention. Next, we describe the current uses for phylogenetics in generalized epidemics and discuss their promise for elucidating transmission patterns and informing prevention trials. Finally, we review logistic and technical challenges inherent to large-scale molecular epidemiological studies of generalized epidemics and suggest potential solutions.
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Affiliation(s)
- Ann M. Dennis
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Andrew Leigh Brown
- Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, UK
| | - Paul Kellam
- Wellcome Trust Sanger Institute, Cambridge, UK
- Division of Infection and Immunity, University College London, London, UK
| | - Tulio de Oliveira
- Wellcome Trust-Africa Centre for Health and Population Studies, University of Kwazula-Natal, ZA
| | - Deenan Pillay
- Division of Infection and Immunity, University College London, London, UK
| | - Christophe Fraser
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Myron S. Cohen
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Marrazzo JM, del Rio C, Holtgrave DR, Cohen MS, Kalichman SC, Mayer KH, Montaner JSG, Wheeler DP, Grant RM, Grinsztejn B, Kumarasamy N, Shoptaw S, Walensky RP, Dabis F, Sugarman J, Benson CA. HIV prevention in clinical care settings: 2014 recommendations of the International Antiviral Society-USA Panel. JAMA 2014; 312:390-409. [PMID: 25038358 PMCID: PMC6309682 DOI: 10.1001/jama.2014.7999] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Emerging data warrant the integration of biomedical and behavioral recommendations for human immunodeficiency virus (HIV) prevention in clinical care settings. OBJECTIVE To provide current recommendations for the prevention of HIV infection in adults and adolescents for integration in clinical care settings. DATA SOURCES, STUDY SELECTION, AND DATA SYNTHESIS Data published or presented as abstracts at scientific conferences (past 17 years) were systematically searched and reviewed by the International Antiviral (formerly AIDS) Society-USA HIV Prevention Recommendations Panel. Panel members supplied additional relevant publications, reviewed available data, and formed recommendations by full-panel consensus. RESULTS Testing for HIV is recommended at least once for all adults and adolescents, with repeated testing for those at increased risk of acquiring HIV. Clinicians should be alert to the possibility of acute HIV infection and promptly pursue diagnostic testing if suspected. At diagnosis of HIV, all individuals should be linked to care for timely initiation of antiretroviral therapy (ART). Support for adherence and retention in care, individualized risk assessment and counseling, assistance with partner notification, and periodic screening for common sexually transmitted infections (STIs) is recommended for HIV-infected individuals as part of care. In HIV-uninfected patients, those persons at high risk of HIV infection should be prioritized for delivery of interventions such as preexposure prophylaxis and individualized counseling on risk reduction. Daily emtricitabine/tenofovir disoproxil fumarate is recommended as preexposure prophylaxis for persons at high risk for HIV based on background incidence or recent diagnosis of incident STIs, use of injection drugs or shared needles, or recent use of nonoccupational postexposure prophylaxis; ongoing use of preexposure prophylaxis should be guided by regular risk assessment. For persons who inject drugs, harm reduction services should be provided (needle and syringe exchange programs, supervised injection, and available medically assisted therapies, including opioid agonists and antagonists); low-threshold detoxification and drug cessation programs should be made available. Postexposure prophylaxis is recommended for all persons who have sustained a mucosal or parenteral exposure to HIV from a known infected source and should be initiated as soon as possible. CONCLUSIONS AND RELEVANCE Data support the integration of biomedical and behavioral approaches for prevention of HIV infection in clinical care settings. A concerted effort to implement combination strategies for HIV prevention is needed to realize the goal of an AIDS-free generation.
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Affiliation(s)
| | | | - David R Holtgrave
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | | | | | | | - Beatriz Grinsztejn
- Evandro Chagas Clinical Research Institute (IPEC)-FIOCRUZ, Rio de Janeiro, Brazil
| | - N Kumarasamy
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
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Grace D, Chown SA, Jollimore J, Parry R, Kwag M, Steinberg M, Trussler T, Rekart M, Gilbert M. HIV-negative gay men's accounts of using context-dependent sero-adaptive strategies. CULTURE, HEALTH & SEXUALITY 2014; 16:316-330. [PMID: 24571102 DOI: 10.1080/13691058.2014.883644] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We enrolled 166 gay and bisexual men who tested HIV-negative at a community sexual health clinic in Vancouver, British Columbia, into a year-long mixed-methods study. A subsample of participants who reported recent condomless anal sex (n = 33) were purposively recruited into an embedded qualitative study and completed two in-depth qualitative interviews. Analysis of baseline interviews elicited three narratives relevant to men's use of context- or relationally-dependent HIV-risk management strategies: (1) seroadaptive behaviours such as partner testing and negotiated safety agreements used with primary sexual partners, (2) serosorting and seroguessing when having sex with new partners and first-time hookups and (3) seroadaptive behaviours, including one or more of seropositioning/strategic positioning, condom serosorting and viral load sorting, used by participants who knowingly had sex with a serodiscordant partner. Within men's talk about sex, we found complex and frequently biomedically-informed rationale for seroadaptation in men's decisions to have what they understood to be various forms of safe or protected condomless anal sex. Our findings support the need for gay men's research and health promotion to meaningfully account for the multiple rationalities and seroadaptive strategies used for having condomless sex in order to be relevant to gay men's everyday sexual decision-making.
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Affiliation(s)
- Daniel Grace
- a Faculty of Medicine , University of British Columbia , Vancouver , Canada
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22
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Acquisition of HIV by African-born residents of Victoria, Australia: insights from molecular epidemiology. PLoS One 2013; 8:e84008. [PMID: 24391866 PMCID: PMC3877143 DOI: 10.1371/journal.pone.0084008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 11/11/2013] [Indexed: 11/19/2022] Open
Abstract
African-born Australians are a recognised "priority population" in Australia's Sixth National HIV/AIDS Strategy. We compared exposure location and route for African-born people living with HIV (PLHIV) in Victoria, Australia, with HIV-1 pol subtype from drug resistance assays and geographical origin suggested by phylogenetic analysis of env gene. Twenty adult HIV positive African-born Victorian residents were recruited via treating doctors. HIV exposure details were obtained from interviews and case notes. Viral RNA was extracted from participant stored plasma or whole blood. The env V3 region was sequenced and compared to globally representative reference HIV-1 sequences in the Los Alamos National Library HIV Database. Twelve participants reported exposure via heterosexual sex and two via iatrogenic blood exposures; four were men having sex with men (MSM); two were exposed via unknown routes. Eight participants reported exposure in their countries of birth, seven in Australia, three in other countries and two in unknown locations. Genotype results (pol) were available for ten participants. HIV env amplification was successful in eighteen cases. HIV-1 subtype was identified in all participants: eight both pol and env; ten env alone and two pol alone. Twelve were subtype C, four subtype B, three subtype A and one subtype CRF02_AG. Reported exposure location was consistent with the phylogenetic clustering of env sequences. African Australians are members of multiple transnational social and sexual networks influencing their exposure to HIV. Phylogenetic analysis may complement traditional surveillance to discern patterns of HIV exposure, providing focus for HIV prevention programs in mobile populations.
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Targeting screening and social marketing to increase detection of acute HIV infection in men who have sex with men in Vancouver, British Columbia. AIDS 2013; 27:2649-54. [PMID: 23921608 PMCID: PMC3814625 DOI: 10.1097/qad.0000000000000001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The contribution of acute HIV infection (AHI) to transmission is widely recognized, and increasing AHI diagnosis capacity can enhance HIV prevention through subsequent behavior change or intervention. We examined the impact of targeted pooled nucleic acid amplification testing (NAAT) and social marketing to increase AHI diagnosis among men who have sex with men (MSM) in Vancouver. DESIGN Observational study. METHODS We implemented pooled NAAT following negative third-generation enzyme immunoassay (EIA) testing for males above 18 years in six clinics accessed by MSM, accompanied by two social marketing campaigns developed by a community gay men's health organization. We compared test volume and diagnosis rates for pre-implementation (April 2006-March 2009) and post-implementation (April 2009-March 2012) periods. After implementation, we used linear regression to examine quarterly trends and calculated diagnostic yield. RESULTS After implementation, the AHI diagnosis rate significantly increased from 1.03 to 1.84 per 1000 tests, as did quarterly HIV test volumes and acute to non-acute diagnosis ratio. Of the 217 new HIV diagnoses after implementation, 54 (24.9%) were AHIs (25 detected by pooled NAAT only) for an increased diagnostic yield of 11.5%. The average number of prior negative HIV tests (past 2 years) increased significantly for newly diagnosed MSM at the six study clinics compared to other newly diagnosed MSM in British Columbia, per quarter. CONCLUSION Targeted implementation of pooled NAAT at clinics accessed by MSM is effective in increasing AHI diagnoses compared to third-generation EIA testing. Social marketing campaigns accompanying pooled NAAT implementation may contribute to increasing AHI diagnoses and frequency of HIV testing.
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Wertheim JO, Leigh Brown AJ, Hepler NL, Mehta SR, Richman DD, Smith DM, Kosakovsky Pond SL. The global transmission network of HIV-1. J Infect Dis 2013; 209:304-13. [PMID: 24151309 DOI: 10.1093/infdis/jit524] [Citation(s) in RCA: 160] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Human immunodeficiency virus type 1 (HIV-1) is pandemic, but its contemporary global transmission network has not been characterized. A better understanding of the properties and dynamics of this network is essential for surveillance, prevention, and eventual eradication of HIV. Here, we apply a simple and computationally efficient network-based approach to all publicly available HIV polymerase sequences in the global database, revealing a contemporary picture of the spread of HIV-1 within and between countries. This approach automatically recovered well-characterized transmission clusters and extended other clusters thought to be contained within a single country across international borders. In addition, previously undescribed transmission clusters were discovered. Together, these clusters represent all known modes of HIV transmission. The extent of international linkage revealed by our comprehensive approach demonstrates the need to consider the global diversity of HIV, even when describing local epidemics. Finally, the speed of this method allows for near-real-time surveillance of the pandemic's progression.
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25
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Read TRH, Hocking JS, Bradshaw CS, Morrow A, Grulich AE, Fairley CK, Chen MY. Provision of rapid HIV tests within a health service and frequency of HIV testing among men who have sex with men: randomised controlled trial. BMJ 2013; 347:f5086. [PMID: 24004988 PMCID: PMC3762440 DOI: 10.1136/bmj.f5086] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine if the provision of rapid HIV testing to men who have sex with men attending a health service would increase their frequency of HIV testing over time. DESIGN Non-blinded randomised controlled trial. SETTING Public sexual health service in Australia. PARTICIPANTS Men who reported having a male sexual partner within the previous year and an HIV test within the previous two years. Of 400 men entered, 370 (92.5%) completed the study. INTERVENTIONS Men attending the service between September 2010 and March 2011 were randomised 1:1 to either ongoing access to rapid HIV testing obtained with finger prick or to conventional HIV serology with venepuncture, over 18 months. MAIN OUTCOME MEASURE The incidence of all HIV testing after enrolment, including testing outside the study clinic, analysed by intention to treat. RESULTS Of 200 men randomised to the rapid testing arm, 196 were followed for 288 person years. Of 200 men randomised to the conventional testing arm, 194 were followed for 278 person years. Median time since the last HIV test was six months for both arms. Men in the rapid test arm had 469 tests (mean 1.63 tests a year), and men in the conventional test arm had 396 tests (mean 1.42 tests a year); incidence rate ratio 1.15, 95% confidence interval 0.96 to 1.38; P=0.12. In a post hoc analysis, rates of initial HIV testing during follow-up were 1.32 and 1.01 tests a year, respectively (1.32, 1.05 to 1.65; P=0.02). CONCLUSIONS Provision of access to rapid HIV testing in a health service did not result in a sustained increase over time in HIV testing by men who have sex with men; however, the rate of initial HIV testing did increase by a third. Further research is required to determine how to achieve sustained increases in the frequency of HIV testing by populations at risk. TRIAL REGISTRATION ACTR No 12610000430033.
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Affiliation(s)
- Tim R H Read
- Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC 3053, Australia.
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26
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Hsu DTS, Ruf M, O'Shea S, Costelloe S, Peck J, Tong CYW. Diagnosing HIV infection in patients presenting with glandular fever-like illness in primary care: are we missing primary HIV infection? HIV Med 2012; 14:60-3. [DOI: 10.1111/j.1468-1293.2012.01023.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2012] [Indexed: 11/28/2022]
Affiliation(s)
- DTS Hsu
- Department of Public Health; NHS Lambeth; London; UK
| | - M Ruf
- Department of Public Health; NHS Lambeth; London; UK
| | - S O'Shea
- GSTS Pathology; St Thomas' Hospital; London; UK
| | - S Costelloe
- Department of Infectious Diseases; St Thomas' Hospital; London; UK
| | - J Peck
- Department of Public Health; NHS Lambeth; London; UK
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