1
|
Gray J, Prestage G, Jin F, Phanuphak N, Friedman RK, Fairley CK, Templeton DJ, Zablotska-Manos I, Hoy J, Bloch M, Baker D, Brown G, Grulich A, Bavinton B. Condom Failure Among HIV-Negative Men in Serodiscordant Relationships in Australia, Brazil, and Thailand. AIDS Behav 2024:10.1007/s10461-024-04431-x. [PMID: 39046613 DOI: 10.1007/s10461-024-04431-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/25/2024]
Abstract
Condoms continue to be used by many gay, bisexual, and other men who have sex with men (GBM) to reduce the risk of HIV transmission. However this is impacted by condom failure events, defined here as condom breakage and slippage. In a prospective, observational cohort study of 343 HIV serodiscordant male couples recruited through high HIV caseload clinics and hospitals between 2012 and 2016 in Australia, Brazil, and Thailand, condom failure rates and associated factors were analysed, including with the study partner versus other sexual partners. There were 717 reported instances of condom failure from an estimated total of 25,831 sex acts with condoms, from over 588.4 participant years of follow up. Of the HIV-negative partners (n = 343) in the study, more than a third (n = 117, 36.7%) reported at least one instance of condom failure with any partner type during study follow-up. Condom failure with their study partner was reported by 91/343 (26.5%) HIV-negative partners, compared with 43/343 (12.5%) who reported condom failure with other partners. In total, there were 86 events where the HIV-negative partner experienced ano-receptive condom failure with ejaculation, representing 12.0% of all failure events. In multivariable analysis, compared to Australia, HIV-negative men in Brazil reported a higher incidence risk rate of condom failure (IRR = 1.64, 95%CI 1.01-2.68, p = 0.046) and HIV-negative men who reported anal sex with other partners reported an increased risk of condom failure compared with men who only had sex with their study partner (IRR = 1.89, 95%CI 1.08-3.33, p = 0.025). Although at least one event of condom failure was reported by a significant proportion of participants, overall condom failure events represented a small proportion of the total condom protected sex acts.
Collapse
Affiliation(s)
- James Gray
- Kirby Institute, UNSW Sydney, Sydney, Australia.
| | | | - Fengyi Jin
- Kirby Institute, UNSW Sydney, Sydney, Australia
| | | | - Ruth K Friedman
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - David J Templeton
- Kirby Institute, UNSW Sydney, Sydney, Australia
- Department of Sexual Health Medicine and Sexual Assault Medical Service, Sydney Local Health District, Sydney, Australia
- Discipline of Medicine, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Iryna Zablotska-Manos
- Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Western Sydney Sexual Health, Western Sydney Local Health District, Sydney, Australia
| | - Jennifer Hoy
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Australia
| | - Mark Bloch
- Kirby Institute, UNSW Sydney, Sydney, Australia
- Holdsworth House, Sydney, Australia
| | | | - Graham Brown
- Centre for Social Impact, UNSW Sydney, Sydney, Australia
| | | | | |
Collapse
|
2
|
Colpani A, De Vito A, Zauli B, Menzaghi B, Calcagno A, Celesia BM, Ceccarelli M, Nunnari G, De Socio GV, Di Biagio A, Leoni N, Angioni G, Giambenedetto SD, D'Ettorre G, Babudieri S, Madeddu G. Knowledge of Sexually Transmitted Infections and HIV among People Living with HIV: Should We Be Concerned? Healthcare (Basel) 2024; 12:417. [PMID: 38391793 PMCID: PMC10888293 DOI: 10.3390/healthcare12040417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/29/2024] [Accepted: 02/02/2024] [Indexed: 02/24/2024] Open
Abstract
Poor knowledge of sexually transmitted infections (STIs) and HIV among people with HIV (PLHIV) could worsen life quality. We aimed to investigate their STI and HIV knowledge, disclosure and undetectable = untransmittable (U=U). We proposed an anonymous questionnaire regarding STI and HIV to PLHIV attending ten Italian outpatient infectious diseases clinics. Moreover, disclosure and U=U were investigated. The calculated sample size was 178 people. Considering a missing response of 10%, the final sample size was 196. We enrolled 200 PLHIV (73.5% males), with a median age of 52.5 (IQR 41-59) years. The mean score was 7.61 ± 1.22 with no difference by gender, education, and employment. Significant statistical difference was observed by sexual orientation; bisexuals and those who preferred not to answer had a lower score than heterosexuals and MSM (p = 0.0032). PLHIV showed poor knowledge about HIV transmission (25% appropriately answered). Nearly 30% responded that virologically suppressed PLHIV could transmit the infection. Finally, 137 (68.5%) and 158 (79.0%) disclosed to the general practitioner and family and friends, respectively. Nearly 52.0% knew the meaning of U=U, and 83.6% highlighted its positive rebound. In conclusion, important knowledge gaps are present among PLHIV regarding U=U, and its implications are little-known. Improving PLHIVs' awareness will undermine self-stigma and enhance life quality.
Collapse
Affiliation(s)
- Agnese Colpani
- Unit of Infectious Disease, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Andrea De Vito
- Unit of Infectious Disease, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Beatrice Zauli
- Unit of Infectious Disease, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Barbara Menzaghi
- Division of Infectious Diseases, "Ospedale di Circolo", 21052 Busto Arsizio, Italy
| | - Andrea Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, 10123 Torino, Italy
| | - Benedetto Maurizio Celesia
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Catania, 95125 Catania, Italy
| | - Manuela Ceccarelli
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Catania, 95125 Catania, Italy
| | - Giuseppe Nunnari
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
| | | | - Antonio Di Biagio
- Infectious Diseases Clinic, IRCCS Policlinico San Martino Hospital, 16132 Genoa, Italy
| | - Nicola Leoni
- Unit of Infectious Disease, SS Trinità Hospital, 09121 Cagliari, Italy
| | - Goffredo Angioni
- Unit of Infectious Disease, SS Trinità Hospital, 09121 Cagliari, Italy
| | - Simona Di Giambenedetto
- Infectious Diseases Unit, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Gabriella D'Ettorre
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, 00185 Rome, Italy
| | - Sergio Babudieri
- Unit of Infectious Disease, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Giordano Madeddu
- Unit of Infectious Disease, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| |
Collapse
|
3
|
Gray J, Prestage G, Jin F, Phanuphak N, Friedman RK, Fairley CK, Kelleher A, Templeton DJ, Zablotska-Manos I, Hoy J, McNulty A, Baker D, Brown G, Grulich A, Bavinton B. Agreements, Behaviour, and Change: Sex Outside the Relationship in Male HIV-negative Partners in HIV Serodiscordant Relationships in Australia, Brazil, and Thailand. AIDS Behav 2023:10.1007/s10461-023-04030-2. [PMID: 36917425 PMCID: PMC10386966 DOI: 10.1007/s10461-023-04030-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 03/15/2023]
Abstract
Male HIV serodiscordant couples have diverse relationship agreements regarding sex outside the relationship. We examined the relationship agreements as described by 343 male HIV-negative partners in HIV serodiscordant relationships in Australia, Brazil and Thailand participating in a multi-year cohort study. At baseline, 125 (34.1%) HIV-negative partners reported no agreement, 115 (33.5%) had a monogamous agreement, and 103 (37.9%) had an open agreement allowing sex outside the relationship. Relationship agreements were largely stable over time, with 76% of HIV-negative men reporting the same agreement across follow up, while changes were predominantly towards having an open agreement. Behaviour largely matched relationship agreements, and the predictors of breaking an agreement by having condomless anal intercourse (CLAI) with an outside partner were CLAI within the relationship (OR = 3.17, 95%CI: 1.64-6.14, p < 0.001) and PrEP use in the last three months (OR = 3.42, 95%CI: 1.48-7.92, p = 0.004). When considering HIV transmission risk for HIV-negative men in serodiscordant relationships, greater focus needs to be placed on sex that is occurring outside the relationship and the agreements that facilitate this.
Collapse
Affiliation(s)
- James Gray
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | | | - Fengyi Jin
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia
| | | | - Ruth K Friedman
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | | | - David J Templeton
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia
- Department of Sexual Health Medicine and Sexual Assault Medical Service, Sydney Local Health District, Camperdown, Australia
- Discipline of Medicine, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Iryna Zablotska-Manos
- Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Western Sydney Sexual Health, Western Sydney Local Health District, Sydney, Australia
| | - Jennifer Hoy
- Department of Infectious Diseases, Alfred Hospital, Monash University, Melbourne, Australia
| | - Anna McNulty
- Sydney Sexual Health Centre, Sydney and Sydney Eye Hospital, Sydney, Australia
- School of Population Health, UNSW Sydney, Sydney, Australia
| | | | - Graham Brown
- Centre for Social Impact, UNSW Sydney, Sydney, Australia
| | - Andrew Grulich
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia
| | | |
Collapse
|
4
|
Wan Mohamad Darani WNS, Chen XW, Samsudin EZ, Mohd Nor F, Ismail I. Determinants of Successful Human Immunodeficiency Virus Treatment Outcomes: A Linkage of National Data Sources in Malaysia. Malays J Med Sci 2023; 30:172-184. [PMID: 36875201 PMCID: PMC9984112 DOI: 10.21315/mjms2023.30.1.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/18/2022] [Indexed: 03/05/2023] Open
Abstract
Background Concerted efforts have been undertaken to reduce the human immunodeficiency virus (HIV) infection by the year 2030 in Malaysia. A situational analysis of the performance of successful HIV treatment and its determinants is vital; however, this information remains scarce. This study aimed to identify the determinants of undetectable viral load among people living with HIV (PLHIV). Methods Newly diagnosed HIV cases (n = 493) registered under the Malaysia HIV/AIDS-related national databases from June 2018 to December 2019 were studied. The deterministic matching method was applied to link the records in two national databases (at Kuala Lumpur and Putrajaya Federal Territories Health Department, JKWPKLP HIV line-listing database and National AIDS Registry). Successful HIV treatment, an outcome variable, was measured by the undetectable viral load < 200 copies/mL after 1 year of antiretroviral therapy initiation. Logistic regression analysis was applied in the current study. Results Results showed that 454/493 (92.2%; 95% confidence interval [CI]: 89.8%, 94.6%) PLHIV had successful HIV treatment. Study participants had a mean (SD) age of 30 (8.10) years old, predominantly male (96.1%) and sexually transmission (99.9%). The multiple logistic regression analysis revealed two significant determinants including the timing of ART initiation (AOR = 3.94; 95% CI: 1.32, 11.70; P = 0.014) and establishment of Sexually Transmitted Infection Friendly Clinic (STIFC) (AOR = 3.40; 95% CI: 1.47, 7.85; P = 0.004). Non-significant variables included gender, education level, HIV risk exposure, and co-infections of tuberculosis and Hepatitis C. Conclusion JKWPKLP is on the right track to achieving universal treatment as a prevention strategy. Reinforcement of early ART initiation and establishment of STIFC are recommended.
Collapse
Affiliation(s)
- Wan Nur Syamimi Wan Mohamad Darani
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia.,HIV Unit, Kuala Lumpur and Putrajaya Federal Territories Health Department (JKWPKLP), Ministry of Health, Kuala Lumpur, Malaysia
| | - Xin Wee Chen
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia.,Institute of Medical Molecular Biotechnology (IMMB), Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
| | - Ely Zarina Samsudin
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
| | - Fadzilah Mohd Nor
- Institute of Medical Molecular Biotechnology (IMMB), Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia.,Department of Medical Microbiology and Parasitology, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia.,Integrative Pharmacogenomics Institute (iPROMISE), Universiti Teknologi MARA, Puncak Alam Campus, Selangor, Malaysia
| | - Ismawati Ismail
- HIV Unit, Kuala Lumpur and Putrajaya Federal Territories Health Department (JKWPKLP), Ministry of Health, Kuala Lumpur, Malaysia
| |
Collapse
|
5
|
De Vito A, Colpani A, Mameli MS, Bagella P, Fiore V, Fozza C, Montesu MA, Fois AG, Filigheddu F, Manzoni N, Putzu C, Babudieri S, Madeddu G. HIV Infection Indicator Disease-Based Active Case Finding in a University Hospital: Results from the SHOT Project. Infect Dis Rep 2023; 15:94-101. [PMID: 36826350 PMCID: PMC9956050 DOI: 10.3390/idr15010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/23/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
In 2014, UNAIDS launched renewed global targets for HIV control to achieve by 2025, known as "the three 95": 95% of people living with HIV (PWH) diagnosed, of which 95% are receiving treatment, of which 95% are on sustained virological suppression. In Italy, new HIV diagnoses have been steadily decreasing since 2012. However, in 2020, 41% of new diagnoses presented with less than 200 CD4+ cells/µL and 60% with less than 350 CD4+ cells/µL. Implementing testing and early treatment is a key strategy to prevent AIDS, late presentation, and HIV transmission. We selected non-Infectious Diseases Units based on the European project HIDES and engaged colleagues in a condition-guided HIV screening strategy. We enrolled 300 patients, of which 202 were males (67.3%) and 98 were females (32.7%). Most of the screening was performed in Infectious Diseases (ID) and Hematologic wards. In total, we diagnosed eleven new HIV infections with a hospital prevalence in the study population of 3.7%. Five (45.4%) had a CD4 count <100/mm3, one (9.1%) <200/mm3, and one (9.1%) <300/mm3. Regarding risk factors, 81.8% declared having had unprotected sexual intercourse and 54.5% were heterosexual. All patients promptly started a combination antiretroviral regimen and 10 (90.9%) obtained an undetectable HIV-RNA status. Eight of the eleven (72.7%) patients are currently on follow-up in our outpatient clinic. A proactive indicator disease-guided screening can help avoid missed opportunities to diagnose HIV infection in a hospital setting. Implementing this kind of intervention could favor early diagnosis and access to treatment.
Collapse
Affiliation(s)
- Andrea De Vito
- Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
- Correspondence: ; Tel.: +39-340-470-4834
| | - Agnese Colpani
- Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Maria Sabrina Mameli
- Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Paola Bagella
- Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Vito Fiore
- Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Claudio Fozza
- Unit of Haematology, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Maria Antonia Montesu
- Unit of Dermatology, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Alessandro Giuseppe Fois
- Unit of Respiratory Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Fabiana Filigheddu
- Unit of Internal Medicine, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Noemi Manzoni
- Unit of Internal Medicine, University Hospital of Sassari, 07100 Sassari, Italy
| | - Carlo Putzu
- Unit of Oncology, University Hospital of Sassari, 07100 Sassari, Italy
| | - Sergio Babudieri
- Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Giordano Madeddu
- Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| |
Collapse
|
6
|
Nunes NN, Vasconcelos R, Cortez AL, Ferreira-Filho E, Kobayasi R, Willets C, Cocuzza M, Avelino-Silva VI. Is U=U consistently known and implemented? A survey among different medical specialists in Brazil. Int J STD AIDS 2023; 34:395-401. [PMID: 36693243 DOI: 10.1177/09564624231153202] [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] [Indexed: 01/25/2023]
Abstract
Despite solid scientific evidence, the concepts of treatment as prevention (TASP) and Undetectable = Untransmittable (U = U) remain unfamiliar and underutilized for some healthcare providers. We conducted a self-completion survey to evaluate the knowledge of TASP/U = U in different medical specialties. Wilcoxon Rank-Sum, Chi-square and Fisher's exact tests were used for group comparisons and a logistic regression model was used to assess factors independently associated with U = U-non-supportive attitudes. 197 physicians were included; 74% agreed/strongly agreed that people living with HIV (PLHIV) under regular treatment with undetectable viral do not transmit HIV sexually. However, only 66% agree/strongly agree that PLHIV should be informed about that. The knowledge about these concepts was poorer among gynecologists, urologists and internal medicine specialists when compared to infectious diseases specialists after adjustment for age, race/skin color, gender, and sexual orientation. Our study found that knowledge of crucial concepts of HIV prevention may be lacking for some medical specialties. This highlights the need of improvement in medical education.
Collapse
Affiliation(s)
- Nathalia Neves Nunes
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR
| | - Ricardo Vasconcelos
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR
| | - Andre Lazzeri Cortez
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR
| | - Edson Ferreira-Filho
- Discipline of Ginecology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR
| | - Renata Kobayasi
- Department of Internal Medicine, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR
| | - Clarissa Willets
- Family Medicine Residency Program, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR
| | - Marcelo Cocuzza
- Department of Urology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR
| | - Vivian I Avelino-Silva
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR
| |
Collapse
|
7
|
Clipman SJ, Mehta SH, Mohapatra S, Srikrishnan AK, Zook KJC, Duggal P, Saravanan S, Nandagopal P, Kumar MS, Lucas GM, Latkin CA, Solomon SS. Deep learning and social network analysis elucidate drivers of HIV transmission in a high-incidence cohort of people who inject drugs. SCIENCE ADVANCES 2022; 8:eabf0158. [PMID: 36260674 PMCID: PMC9581475 DOI: 10.1126/sciadv.abf0158] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 08/31/2022] [Indexed: 06/16/2023]
Abstract
Globally, people who inject drugs (PWID) experience some of the fastest-growing HIV epidemics. Network-based approaches represent a powerful tool for understanding and combating these epidemics; however, detailed social network studies are limited and pose analytical challenges. We collected longitudinal social (injection partners) and spatial (injection venues) network information from 2512 PWID in New Delhi, India. We leveraged network analysis and graph neural networks (GNNs) to uncover factors associated with HIV transmission and identify optimal intervention delivery points. Longitudinal HIV incidence was 21.3 per 100 person-years. Overlapping community detection using GNNs revealed seven communities, with HIV incidence concentrated within one community. The injection venue most strongly associated with incidence was found to overlap six of the seven communities, suggesting that an intervention deployed at this one location could reach the majority of the sample. These findings highlight the utility of network analysis and deep learning in HIV program design.
Collapse
Affiliation(s)
- Steven J. Clipman
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shruti H. Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shobha Mohapatra
- YR Gaitonde Centre for AIDS Research and Education (YRGCARE), Chennai, India
| | | | - Katie J. C. Zook
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Priya Duggal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shanmugam Saravanan
- YR Gaitonde Centre for AIDS Research and Education (YRGCARE), Chennai, India
| | | | | | - Gregory M. Lucas
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carl A. Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sunil S. Solomon
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
8
|
Cingolani A, Tavelli A, Calvino GV, Maggiolo F, Girardi E, Cozzi-Lepri A, Perziano A, Meli P, Camposeragna A, Mattioli S, Calzavara D, Gagliardini R, Nozza S, Antinori A, d'Arminio Monforte A. Awareness and perception of accuracy of the Undetectable=Untransmittable message (U=U) in Italy: results from a survey among PLWHA, infectious-diseases physicians and people having unprotected sex. AIDS Care 2022; 35:923-933. [PMID: 35579404 DOI: 10.1080/09540121.2022.2074960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Evidences on the absence of risk of sexual transmission of HIV by persons living with HIV/AIDS (PLWHA) with undetectable plasma HIV-RNA (HIV-RNA <200 copies/ml) led to the worldwide campaign "U = U" (undetectable = untransmittable). The purpose of this study was to evaluate the perceived accuracy of this message among PLWHA, HIV-negative people having unprotected sex (PHUS) and infectious diseases' (ID) physicians in Italy. A nationwide survey has been conducted using three different anonymous questionnaires (for ID physicians, PLWHA and PHUS). A total of 1121 participants filled the questionnaires: 397 PLWHA; 90 physicians; 634 PHUS. Awareness of U = U message has been reported in 74%, 92% and 47% of PLWHA, ID physicians and PHUS, respectively. The perception of accuracy of the U = U message among those aware was reported as high in 80.4%, 79.5% and 67.3% of PLWHA, ID physicians and PHUS, respectively. Physicians perceived that 11% of PLWHA have a high rate of perception of U = U, whereas among PLWHA, only 34% reported definitive positive messages from physicians. Discrepancies between awareness and perception of accuracy of the message U = U in PLWHA and physicians have been found, suggesting still low confidence in the community regarding the message itself.
Collapse
Affiliation(s)
- A Cingolani
- Fondazione Policlinico A. Gemelli IRCCS, Catholic University of the Sacred Heart, Infectious Diseases Unit, Rome, Italy
| | | | | | - F Maggiolo
- Division of Infectious Diseases, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - E Girardi
- National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Epidemiology Unit, Rome, Italy
| | | | - A Perziano
- Associazione Arcobaleno AIDS, Torino, Italy
| | - P Meli
- Associazione Comunità Emmaus, Bergamo Fast Track City, Italy
| | - A Camposeragna
- Coordinamento Nazionale Comunita' di Accoglienza (CNCA), Roma, Italy
| | | | | | - R Gagliardini
- HIV/AIDS Department, National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - S Nozza
- Department of Infectious Diseases, San Raffaele Scientific Institute IRCCS, Milan, Italy
| | - A Antinori
- HIV/AIDS Department, National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - A d'Arminio Monforte
- ASST Santi Paolo e Carlo, University of Milan, Infectious Diseases Unit, Milan, Italy for ICONA Fundation Study Group
| | -
- Fondazione Policlinico A. Gemelli IRCCS, Catholic University of the Sacred Heart, Infectious Diseases Unit, Rome, Italy
| |
Collapse
|
9
|
Gray J, Prestage G, Jin F, Phanuphak N, Friedman RK, Fairley CK, Kelleher A, Templeton D, Zablotska-Manos I, Hoy J, McNulty A, Pell C, Grulich A, Bavinton B. Characteristics of Agreements to have Condomless Anal Intercourse in the Presence of an Undetectable Viral Load Among HIV Serodiscordant Male Couples in Australia, Brazil and Thailand. AIDS Behav 2021; 25:3944-3954. [PMID: 34109529 DOI: 10.1007/s10461-021-03324-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
The use of undetectable viral load (VL) to negotiate condomless anal intercourse (CLAI) in HIV serodiscordant male relationships has become more common as more data regarding the effectiveness of antiretroviral treatments for the prevention of HIV transmission has been described. We examined viral load agreements (VLAs) for condomless sex in the presence of an undetectable VL in 343 HIV serodiscordant male couples in Australia, Brazil and Thailand. Factors associated with having a VLA included having agreements for the HIV-positive partner to report his VL result (p < 0.001), agreeing that VL affects agreements about sexual practice (p < 0.001), the HIV-negative partner's perception of his partner's undetectable VL (p < 0.001), the couple's belief in the efficacy of undetectable VL in preventing HIV transmission (p < 0.001), and the couple engaging in CLAI with each other (p < 0.001). Over time, these agreements became more common although 49.3% of couples in the sample never had a viral load agreement. As these agreements become more common, further education is required to support male couples in using them safely.
Collapse
|
10
|
Antela A, Rivero A, Llibre JM, Moreno S. Redefining therapeutic success in HIV patients: an expert view. J Antimicrob Chemother 2021; 76:2501-2518. [PMID: 34077524 PMCID: PMC8446931 DOI: 10.1093/jac/dkab168] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Thanks to advances in the field over the years, HIV/AIDS has now become a manageable chronic condition. Nevertheless, a new set of HIV-associated complications has emerged, related in part to the accelerated ageing observed in people living with HIV/AIDS, the cumulative toxicities from exposure to antiretroviral drugs over decades and emerging comorbidities. As a result, HIV/AIDS can still have a negative impact on patients' quality of life (QoL). In this scenario, it is reasonable to believe that the concept of therapeutic success, traditionally associated with CD4 cell count restoration and HIV RNA plasma viral load suppression and the absence of drug resistances, needs to be redefined to include other factors that reach beyond antiretroviral efficacy. With this in mind, a group of experts initiated and coordinated the RET Project, and this group, using the available evidence and their clinical experience in the field, has proposed new criteria to redefine treatment success in HIV, arranged into five main concepts: rapid initiation, efficacy, simplicity, safety, and QoL. An extensive review of the literature was performed for each category, and results were discussed by a total of 32 clinicians with experience in HIV/AIDS (4 coordinators + 28 additional experts). This article summarizes the conclusions of these experts and presents the most updated overview on the five topics, along with a discussion of the experts' main concerns, conclusions and/or recommendations on the most controversial issues.
Collapse
Affiliation(s)
- Antonio Antela
- Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Antonio Rivero
- Hospital Universitario Reina Sofía, Cordoba, Spain
- Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain
| | - Josep M Llibre
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Santiago Moreno
- Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| |
Collapse
|
11
|
Gunn JKL, Patterson W, Anderson BJ, Swain CA. Understanding the Risk of Human Immunodeficiency Virus (HIV) Virologic Failure in the Era of Undetectable Equals Untransmittable. AIDS Behav 2021; 25:2259-2265. [PMID: 33439374 PMCID: PMC8165059 DOI: 10.1007/s10461-020-03154-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2020] [Indexed: 01/05/2023]
Abstract
The “Undetectable = Untransmittable” campaign indicates that persons living with Human Immunodeficiency Virus (HIV) who maintain a suppressed viral load cannot sexually transmit the virus. However, there is little knowledge of the percent of individuals at a population level who sustain viral suppression long term. The aims of this study were to: (1) establish a baseline of persons living with diagnosed HIV who resided in New York and had consecutive suppressed viral load tests; (2) describe the risk of virologic failure among those who were consecutively suppressed; and (3) gain an understanding of the length of time between consecutive viral suppression to virologic failure. A total of 102,339 New Yorkers aged 13–90 years were living with diagnosed HIV at the beginning of 2012; 47.9% were consecutively suppressed (last two HIV viral load test results from 2010–2011 that were < 420 days apart and < 200 copies/mL). Of consecutively suppressed individuals, 54.3% maintained viral suppression for the entire study period and 33.6% experienced virologic failure during the study period. Among persons who experienced virologic failure, 82.6% did so six or more months after being consecutively suppressed. Our findings support the need for ongoing viral load monitoring, adherence support, and ongoing risk reduction messaging to prevent forward HIV transmission.
Collapse
Affiliation(s)
- Jayleen K L Gunn
- New York State Department of Health, Albany, NY, USA
- United States Public Health Service, Washington, USA
| | | | | | - Carol-Ann Swain
- New York State Department of Health, Albany, NY, USA.
- Department of Health, AIDS Institute, Bureau of HIV/AIDS Epidemiology, New York State, Corning Tower, Albany, NY, USA.
| |
Collapse
|
12
|
Erdinc FS, Dokuzoguz B, Unal S, Komur S, Inkaya AC, Inan D, Karaoglan I, Deveci A, Celen MK, Kose S, Erben N, Senturk GC, Heper Y, Kutlu SS, Hatipoglu CA, Sumer S, Kandemir B, Sirmatel F, Bayindir Y, Yilmaz E, Ersoy Y, Kazak E, Yildirmak MT, Kayaaslan B, Ozden K, Sener A, Kara A, Gunal O, Birengel S, Akbulut A, Yetkin F, Cuvalci NO, Sargin F, Pullukcu H, Gokengin D, Multicentric Hiv Study Group. Temporal Trends in the Epidemiology of HIV in Turkey. Curr HIV Res 2021; 18:258-266. [PMID: 32342820 DOI: 10.2174/1570162x18666200427223823] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/03/2020] [Accepted: 04/14/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The aim of this study was to analyze the temporal trends of HIV epidemiology in Turkey from 2011 to 2016. METHODS Thirty-four teams from 28 centers at 17 different cities participated in this retrospective study. Participating centers were asked to complete a structured form containing questions about epidemiologic, demographic and clinical characteristics of patients presented with new HIV diagnosis between 2011 and 2016. Demographic data from all centers (complete or partial) were included in the analyses. For the cascade of care analysis, 15 centers that provided full data from 2011 to 2016 were included. Overall and annual distributions of the data were calculated as percentages and the Chi square test was used to determine temporal changes. RESULTS A total of 2,953 patients between 2011 and 2016 were included. Overall male to female ratio was 5:1 with a significant increase in the number of male cases from 2011 to 2016 (p<0.001). The highest prevalence was among those aged 25-34 years followed by the 35-44 age bracket. The most common reason for HIV testing was illness (35%). While the frequency of sex among men who have sex with men increased from 16% to 30.6% (p<0.001) over the study period, heterosexual intercourse (53%) was found to be the most common transmission route. Overall, 29% of the cases presented with a CD4 count of >500 cells/mm3 while 46.7% presented with a CD4 T cell count of <350 cells/mm3. Among newly diagnosed cases, 79% were retained in care, and all such cases initiated ART with 73% achieving viral suppression after six months of antiretroviral therapy. CONCLUSION The epidemiologic profile of HIV infected individuals is changing rapidly in Turkey with an increasing trend in the number of newly diagnosed people disclosing themselves as MSM. New diagnoses were mostly at a young age. The late diagnosis was found to be a challenging issue. Despite the unavailability of data for the first 90, Turkey is close to the last two steps of 90-90-90 targets.
Collapse
Affiliation(s)
- F S Erdinc
- Ankara Training and Research Hospital, Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - B Dokuzoguz
- Ankara Numune Training and Researh Hospital, Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - S Unal
- Hacettepe Universitesi Hastaneleri, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - S Komur
- Cukurova University, Department of Infectious Diseases and Clinical Microbiology, Adana, Turkey
| | - A C Inkaya
- Ankara Numune Training and Researh Hospital, Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - D Inan
- Akdeniz University, Department of Infectious Diseases and Clinical Microbiology, Antalya, Turkey
| | - I Karaoglan
- Gaziantep University, Department of Infectious Diseases and Clinical Microbiology, Gaziantep, Turkey
| | - A Deveci
- Ondokuz Mayis University, Department of Infectious Diseases and Clinical Microbiology, Samsun, Turkey
| | - M K Celen
- Dicle University, Department of Infectious Diseases and Clinical Microbiology, Diyarbakır, Turkey
| | - S Kose
- Izmir Tepecik Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, İzmir, Turkey
| | - N Erben
- Eskisehir Osmangazi University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Eskisehir, Turkey
| | - G C Senturk
- Diskapi Yildirim Beyazit Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Y Heper
- Uludag University, Department of Infectious Diseases and Clinical Microbiology, Bursa, Turkey
| | - S S Kutlu
- Pamukkale University, Department of Infectious Diseases and Clinical Microbiology, Denizli, Turkey
| | - C A Hatipoglu
- Ankara Training and Research Hospital, Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - S Sumer
- Selcuk University, Department of Infectious Diseases and Clinical Microbiology, Konya, Turkey
| | - B Kandemir
- Necmettin Erbakan University, Meram Medical Faculty Hospital, Department of Infectious Diseases and Clinical Microbiology, Konya, Turkey
| | - F Sirmatel
- Abant Izzet Baysal University, Department of Infectious Diseases and Clinical Microbiology, Bolu, Turkey
| | - Y Bayindir
- Inonu University, Department of Infectious Diseases and Clinical Microbiology, Malatya, Turkey
| | - E Yilmaz
- Uludag University, Department of Infectious Diseases and Clinical Microbiology, Bursa, Turkey
| | - Y Ersoy
- Inonu University, Department of Infectious Diseases and Clinical Microbiology, Malatya, Turkey
| | - E Kazak
- Uludag University, Department of Infectious Diseases and Clinical Microbiology, Bursa, Turkey
| | - M T Yildirmak
- Okmeydani Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - B Kayaaslan
- Yildirim Beyazit University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - K Ozden
- Ataturk University, Department of Infectious Diseases and Clinical Microbiology, Erzurum, Turkey
| | - A Sener
- Canakkale Onsekiz Mart University, Department of Infectious Diseases and Clinical Microbiology, Canakkale, Turkey
| | - A Kara
- Hacettepe University Ihsan Dogramaci Children's Hospital, Department of Infectious Diseases, Ankara, Turkey
| | - O Gunal
- Samsun Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Samsun, Turkey
| | - S Birengel
- Ankara University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - A Akbulut
- Firat University, Department of Infectious Diseases and Clinical Microbiology, Elazig, Turkey
| | - F Yetkin
- Inonu University, Department of Infectious Diseases and Clinical Microbiology, Malatya, Turkey
| | - N O Cuvalci
- Antalya Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Antalya, Turkey
| | - F Sargin
- Medeniyet University Goztepe Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - H Pullukcu
- Ege University, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | - D Gokengin
- Ege University, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | | |
Collapse
|
13
|
Maatouk I, Jaspal R. Barriers to HIV treatment as prevention (TasP) in men who have sex with men in the Eastern Mediterranean Region. J Public Health (Oxf) 2021; 42:e513-e515. [PMID: 31915825 DOI: 10.1093/pubmed/fdz186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 11/14/2019] [Accepted: 12/11/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ismael Maatouk
- Dermatology Department, Clemenceau Medical Center, Johns Hopkins International, Beirut, Lebanon.,Faculty of Health and Life Sciences, De Montfort University, Leicester LE1-9BH, UK
| | - Rusi Jaspal
- Faculty of Health and Life Sciences, De Montfort University, Leicester LE1-9BH, UK
| |
Collapse
|
14
|
Undetectable viral load and HIV transmission dynamics on an individual and population level: where next in the global HIV response? Curr Opin Infect Dis 2021; 33:20-27. [PMID: 31743122 DOI: 10.1097/qco.0000000000000613] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To examine recent literature on the efficacy and effectiveness of HIV treatment in preventing HIV transmission through sexual exposure, at both an individual and at a population level. RECENT FINDINGS Two recent studies on the individual-level efficacy of treatment as prevention (TasP) have added to the now conclusive evidence that HIV cannot be transmitted sexually when the virus is suppressed. However, four large cluster-randomized population-level trials on universal HIV testing and treatment in Africa have not delivered the expected impact in reducing HIV incidence at a population level. Two of these trials showed no differences in HIV incidence between the intervention and control arms, one demonstrated a nonsignificant lower incidence in the intervention arm, and the fourth trial found a reduction between the communities receiving a combination prevention package and the control arm, but no difference between the immediate treatment plus the prevention package and the control arm. Factors contributing to the disconnect between individual high-level efficacy and population-level effectiveness of TasP include undiagnosed infection, delays in linkage to care, challenges in retention and adherence to antiretroviral therapy (ART), time between ART initiation and viral suppression, and stigma and discrimination. SUMMARY Suppressive ART renders people living with HIV sexually noninfectious. However, epidemic control is unlikely to be achieved by TasP alone.
Collapse
|
15
|
Mayer KH, Nelson L, Hightow-Weidman L, Mimiaga MJ, Mena L, Reisner S, Daskalakis D, Safren SA, Beyrer C, Sullivan PS. The persistent and evolving HIV epidemic in American men who have sex with men. Lancet 2021; 397:1116-1126. [PMID: 33617771 PMCID: PMC9639667 DOI: 10.1016/s0140-6736(21)00321-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 08/03/2020] [Accepted: 09/25/2020] [Indexed: 01/06/2023]
Abstract
Men who have sex with men (MSM) in the USA were the first population to be identified with AIDS and continue to be at very high risk of HIV acquisition. We did a systematic literature search to identify the factors that explain the reasons for the ongoing epidemic in this population, using a social-ecological perspective. Common features of the HIV epidemic in American MSM include role versatility and biological, individual, and social and structural factors. The high-prevalence networks of some racial and ethnic minority men are further concentrated because of assortative mixing, adverse life experiences (including high rates of incarceration), and avoidant behaviour because of negative interactions with the health-care system. Young MSM have additional risks for HIV because their impulse control is less developed and they are less familiar with serostatus and other risk mitigation discussions. They might benefit from prevention efforts that use digital technologies, which they often use to meet partners and obtain health-related information. Older MSM remain at risk of HIV and are the largest population of US residents with chronic HIV, requiring culturally responsive programmes that address longer-term comorbidities. Transgender MSM are an understudied population, but emerging data suggest that some are at great risk of HIV and require specifically tailored information on HIV prevention. In the current era of pre-exposure prophylaxis and the undetectable equals untransmittable campaign, training of health-care providers to create culturally competent programmes for all MSM is crucial, since the use of antiretrovirals is foundational to optimising HIV care and prevention. Effective control of the HIV epidemic among all American MSM will require scaling up programmes that address their common vulnerabilities, but are sufficiently nuanced to address the specific sociocultural, structural, and behavioural issues of diverse subgroups.
Collapse
Affiliation(s)
- Kenneth H Mayer
- Beth Israel Deaconess Medical Center, Harvard Medical School, Fenway Health, Boston, MA, USA.
| | - LaRon Nelson
- School of Nursing, Yale University, New Haven, CT, USA
| | | | - Matthew J Mimiaga
- Fielding School of Public Health and David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Leandro Mena
- Medical Center, University of Mississippi, Jackson, MS, USA
| | - Sari Reisner
- Boston Children's Hospital, Fenway Health, Boston, MA, USA
| | | | | | - Chris Beyrer
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | |
Collapse
|
16
|
Luz PM, Torres TS, Almeida-Brasil CC, Marins LMS, Veloso VG, Grinsztejn B, Cox J, Moodie EEM. High-Risk Sexual Behavior, Binge Drinking and Use of Stimulants are Key Experiences on the Pathway to High Perceived HIV Risk Among Men Who Have Sex with Men in Brazil. AIDS Behav 2021; 25:748-757. [PMID: 32940826 DOI: 10.1007/s10461-020-03035-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In Brazil, pre-exposure prophylaxis (PrEP) is currently available for gay, bisexual, and other men who have sex with men. As PrEP use depends on an individual's perceived risk, we explored pathways by which potentially modifiable behaviors lead to high perceived HIV risk. Using online surveys (N = 16,667), we conducted a path analysis on the basis of ordered sequences of multivariate logistic regressions. High perceived HIV risk was low (26.3%) compared to condomless receptive anal sex (41.4%). While younger age increased the odds of binge drinking and of condomless receptive anal sex, it was associated with decreased odds of high perceived HIV risk. In contrast, use of stimulants increased the odds of condomless receptive anal sex and of high perceived HIV risk. Our results suggest that binge drinking and use of stimulants are key points in different pathways to high-risk sexual behavior and may lead to different perceptions of HIV risk.
Collapse
Affiliation(s)
- Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil.
| | - Thiago S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | | | - Luana M S Marins
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Joseph Cox
- Research Institute of the McGill University Health Centre, Montreal, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Canada
| | - Erica E M Moodie
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Canada
| |
Collapse
|
17
|
Dawson L, Benbow N, Fletcher FE, Kassaye S, Killelea A, Latham SR, Lee LM, Leitner T, Little SJ, Mehta SR, Martinez O, Minalga B, Poon A, Rennie S, Sugarman J, Sweeney P, Torian LV, Wertheim JO. Addressing Ethical Challenges in US-Based HIV Phylogenetic Research. J Infect Dis 2020; 222:1997-2006. [PMID: 32525980 PMCID: PMC7661760 DOI: 10.1093/infdis/jiaa107] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 03/06/2020] [Indexed: 12/29/2022] Open
Abstract
In recent years, phylogenetic analysis of HIV sequence data has been used in research studies to investigate transmission patterns between individuals and groups, including analysis of data from HIV prevention clinical trials, in molecular epidemiology, and in public health surveillance programs. Phylogenetic analysis can provide valuable information to inform HIV prevention efforts, but it also has risks, including stigma and marginalization of groups, or potential identification of HIV transmission between individuals. In response to these concerns, an interdisciplinary working group was assembled to address ethical challenges in US-based HIV phylogenetic research. The working group developed recommendations regarding (1) study design; (2) data security, access, and sharing; (3) legal issues; (4) community engagement; and (5) communication and dissemination. The working group also identified areas for future research and scholarship to promote ethical conduct of HIV phylogenetic research.
Collapse
Affiliation(s)
- Liza Dawson
- Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Nanette Benbow
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Faith E Fletcher
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Seble Kassaye
- Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Amy Killelea
- National Alliance of State and Territorial AIDS Directors, Washington, District of Columbia, USA
| | - Stephen R Latham
- Yale Interdisciplinary Center for Bioethics, New Haven, Connecticut, USA
| | - Lisa M Lee
- Virginia Tech, Blacksburg, Virginia, USA
| | - Thomas Leitner
- Los Alamos National Laboratory, Los Alamos, New Mexico, USA
| | - Susan J Little
- University of California at San Diego, San Diego, California, USA
| | - Sanjay R Mehta
- University of California at San Diego, San Diego, California, USA
| | | | - Brian Minalga
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Art Poon
- University of Western Ontario, London, Ontario, Canada
| | - Stuart Rennie
- University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Patricia Sweeney
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lucia V Torian
- New York City Department of Health, New York, New York, USA
| | - Joel O Wertheim
- University of California at San Diego, San Diego, California, USA
| |
Collapse
|
18
|
Philpot SP, Persson A, Prestage G, Bavinton BR, Ellard J. The 'normality' of living as a gay serodiscordant couple in Sydney, Australia. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:1837-1857. [PMID: 32767697 DOI: 10.1111/1467-9566.13171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 06/23/2020] [Accepted: 07/14/2020] [Indexed: 06/11/2023]
Abstract
Serodiscordant couples are often understood through a discourse of HIV-risk or researched in terms of the psychological stressors they face. However, due to antiretroviral treatments people living with HIV can achieve undetectable viral loads, which not only make them non-infectious to partners, but allow them to think of their lives and relationships as safe and viable. These realisations mean that serodiscordant couples often embrace an HIV 'normalisation' discourse. In this article, we argue that this discourse of HIV 'normalisation' can overlook the more nuanced complexity of issues still faced by couples today, which reveal how their experiences of 'normal' are sometimes challenged and are not necessarily 'normal'. Utilising semi-structured interviews with 21 gay men in serodiscordant relationships in Sydney, Australia, we draw on the concept of 'home' life to explore how men engage with discourses of normalisation to describe and enact their relationships. We argue that although HIV is managed well enough to be insignificant in the context of home life, experiences or anticipation of stigma in public often remind couples that they are yet to be considered 'normal' socially.
Collapse
Affiliation(s)
| | - Asha Persson
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | | | | | - Jeanne Ellard
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| |
Collapse
|
19
|
Bavinton BR, Prestage GP, Jin F, Phanuphak N, Grinsztejn B, Fairley CK, Baker D, Hoy J, Templeton DJ, Tee BK, Kelleher A, Grulich AE. Strategies used by gay male HIV serodiscordant couples to reduce the risk of HIV transmission from anal intercourse in three countries. J Int AIDS Soc 2020; 22:e25277. [PMID: 30983155 PMCID: PMC6462805 DOI: 10.1002/jia2.25277] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 03/15/2019] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION There are few data about the range of strategies used to prevent sexual HIV transmission within gay male serodiscordant couples. We examined HIV prevention strategies used by such couples and compared differences between countries. METHODS Opposites Attract was a cohort study of male serodiscordant couples in Australia, Brazil and Thailand, from May 2014 (Australia) or May 2016 (Brazil/Thailand) to December 2016. At visits, HIV-positive partners had viral load (VL) tested; HIV-negative partners reported sexual behaviour and perceptions of their HIV-positive partner's VL results. Within-couple acts of condomless anal intercourse (CLAI) were categorized by strategy: condom-protected, biomedically protected (undetectable VL and/or pre-exposure prophylaxis [PrEP]), or not protected by either (HIV-negative partners engaging in insertive CLAI, receptive CLAI with withdrawal, or receptive CLAI with ejaculation). RESULTS A total of 343 couples were included in this analysis (153 in Australia, 93 in Brazil and 97 in Thailand). Three-quarters of HIV-positive partners were consistently virally suppressed (<200 copies/mL) during follow-up, and HIV-negative partners had correct perceptions of their partner's VL result for 76.5% of tests. One-third of HIV-negative partners used daily PrEP during follow-up. Over follow-up, 73.8% of couples had CLAI. HIV-negative partners reported 31,532 acts of anal intercourse with their HIV-positive partner. Of these, 46.7% were protected by condoms, 48.6% by a biomedical strategy and 4.7% of acts were not protected by these strategies. Australian couples had fewer condom-protected acts and a higher proportion of biomedically protected acts than Brazilian and Thai couples. Of the 1473 CLAI acts where the perceived VL was detectable/unknown and were not protected by PrEP (4.7% of all acts), two-thirds (n = 983) were when the HIV-negative partner was insertive (strategic positioning). Of the 490 acts when the HIV-negative partner was receptive, 261 involved withdrawal and 280 involved ejaculation. Thus, <1% of acts were in the highest risk category of receptive CLAI with ejaculation. CONCLUSIONS Couples used condoms, PrEP or perceived undetectable VL for prevention in the majority of anal intercourse acts. Only a very small proportion of events were not protected by these strategies. Variation between countries may reflect differences in access to HIV treatment, education, knowledge and attitudes.
Collapse
Affiliation(s)
| | | | - Fengyi Jin
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | | | - Beatriz Grinsztejn
- Evandro Chagas Institute of Clinical Research (IPEC), FIOCRUZ, Rio de Janeiro, Brazil
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Melbourne, Australia.,Monash University, Melbourne, Australia
| | | | - Jennifer Hoy
- Monash University, Melbourne, Australia.,The Alfred Hospital, Melbourne, Australia
| | - David J Templeton
- The Kirby Institute, UNSW Sydney, Sydney, Australia.,RPA Sexual Health, Sydney, Australia
| | | | | | | | | |
Collapse
|
20
|
Sun L, Liu A, Li J, Shao Y, Li Q, Ye J, Zhang H, Li Z, Wang H. Is PrEP necessary during natural conception in HIV-1-serodiscordant couples on ART with suppressed viral load? A retrospective cohort analysis. BMC Infect Dis 2020; 20:195. [PMID: 32138673 PMCID: PMC7059657 DOI: 10.1186/s12879-020-4912-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 02/20/2020] [Indexed: 11/10/2022] Open
Abstract
Background Antiretroviral therapy (ART) demonstrates high efficacy in reducing the risk of HIV transmission to sexual partners. However, it is not clear if the use of pre-exposure prophylaxis (PrEP) in HIV-1-serodiscordant couples is necessary during natural conception when the HIV-positive partner exhibits a suppressed viral load. The purpose of this study was to assess the role of PrEP during natural conception in this population. Methods A retrospective, multicenter study was conducted in a cohort of HIV-1-serodiscordant couples (positive man, negative woman) with childbearing desires. HIV-positive male partners were treated with ART and achieved viral suppression for more than half a year. The HIV-negative female partners were either treated with PrEP or not treated with PrEP, and outcomes were compared between the two treatment groups. Results Of 246 HIV-1-serodiscordant couples in whom the HIV-positive partner achieved viral suppression, 104 seronegative women were treated with PrEP during natural conception and 142 seronegative women were not treated with PrEP. There were 410 condom-less sexual acts in couples treated with PrEP and 615 condom-less sexual acts in couples not treated with PrEP. We observed no instances of HIV transmission in HIV-1-serodiscordant couples with or without the use of PrEP during the process of natural conception. Conclusions Our results show that PrEP had minimal influence in reducing the risk of HIV transmission during natural conception in HIV-1-serodiscordant couples with a stably suppressed viral load. Thus, it may be an acceptable option for HIV-negative partners to not use PrEP during the process of natural conception if the HIV-positive partner has achieved viral suppression for more than half a year.
Collapse
Affiliation(s)
- Lijun Sun
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - An Liu
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - Jianwei Li
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - Ying Shao
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - Qiuyun Li
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - Jiangzhu Ye
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - Hongwei Zhang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - Zaicun Li
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China.
| | - Hui Wang
- Department of Infectious Diseases, Shenzhen Third People's Hospital, Shenzhen, 518112, China.
| |
Collapse
|
21
|
LeMessurier J, Traversy G, Varsaneux O, Weekes M, Avey MT, Niragira O, Gervais R, Guyatt G, Rodin R. Risk of sexual transmission of human immunodeficiency virus with antiretroviral therapy, suppressed viral load and condom use: a systematic review. CMAJ 2019; 190:E1350-E1360. [PMID: 30455270 DOI: 10.1503/cmaj.180311] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The Public Health Agency of Canada reviewed sexual transmission of HIV between serodiscordant partners to support examination of the criminal justice system response to HIV nondisclosure by the Department of Justice of Canada. We sought to determine HIV transmission risk when an HIV-positive partner takes antiretroviral therapy, has a suppressed viral load or uses condoms. METHODS We conducted an overview and systematic review update by searching MEDLINE and other databases (Jan. 1, 2007, to Mar. 13, 2017; and Nov. 1, 2012, to Apr. 27, 2017, respectively). We considered reviews and studies about absolute risk of sexual transmission of HIV between serodiscordant partners to be eligible for inclusion. We used A Measurement Tool to Assess Systematic Reviews (AMSTAR) for review quality, Quality in Prognosis Studies (QUIPS) instrument for study risk of bias and then the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to assess the quality of evidence across studies. We calculated HIV incidence per 100 person-years with 95% confidence intervals (CIs). We assigned risk categories according to potential for and evidence of HIV transmission. RESULTS We identified 12 reviews. We selected 1 review to estimate risk of HIV transmission for condom use without antiretroviral therapy (1.14 transmissions/100 person-years, 95% CI 0.56-2.04; low risk). We identified 11 studies with 23 transmissions over 10 511 person-years with antiretroviral therapy (0.22 transmissions/ 100 person-years, 95% CI 0.14-0.33; low risk). We found no transmissions with antiretroviral therapy and a viral load of less than 200 copies/mL across consecutive measurements 4 to 6 months apart (0.00 transmissions/100 person-years, 95% CI 0.00-0.28; negligible risk regardless of condom use). INTERPRETATION Based on high-quality evidence, there is a negligible risk of sexual transmission of HIV when an HIV-positive sex partner adheres to antiretroviral therapy and maintains a suppressed viral load of less than 200 copies/mL measured every 4 to 6 months. Sexual transmissions of HIV have occurred when viral load was more than 200 copies/mL with antiretroviral therapy or condoms alone were used, although the risk remains low. These findings will help to support patient and clinician decision-making, affect public health case management and contact tracing, and inform justice system responses to HIV nondisclosure.
Collapse
Affiliation(s)
- Jennifer LeMessurier
- Centre for Communicable Diseases and Infection Control (Traversy, Varsaneux, Weekes, Avey, Niragira, Gervais, Rodin), Public Health Agency of Canada; Department of Family Medicine (LeMessurier) and School of Epidemiology and Public Health (LeMessurier), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence, and Impact (Guyatt), McMaster University, Hamilton, Ont
| | - Gregory Traversy
- Centre for Communicable Diseases and Infection Control (Traversy, Varsaneux, Weekes, Avey, Niragira, Gervais, Rodin), Public Health Agency of Canada; Department of Family Medicine (LeMessurier) and School of Epidemiology and Public Health (LeMessurier), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence, and Impact (Guyatt), McMaster University, Hamilton, Ont
| | - Olivia Varsaneux
- Centre for Communicable Diseases and Infection Control (Traversy, Varsaneux, Weekes, Avey, Niragira, Gervais, Rodin), Public Health Agency of Canada; Department of Family Medicine (LeMessurier) and School of Epidemiology and Public Health (LeMessurier), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence, and Impact (Guyatt), McMaster University, Hamilton, Ont
| | - Makenzie Weekes
- Centre for Communicable Diseases and Infection Control (Traversy, Varsaneux, Weekes, Avey, Niragira, Gervais, Rodin), Public Health Agency of Canada; Department of Family Medicine (LeMessurier) and School of Epidemiology and Public Health (LeMessurier), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence, and Impact (Guyatt), McMaster University, Hamilton, Ont
| | - Marc T Avey
- Centre for Communicable Diseases and Infection Control (Traversy, Varsaneux, Weekes, Avey, Niragira, Gervais, Rodin), Public Health Agency of Canada; Department of Family Medicine (LeMessurier) and School of Epidemiology and Public Health (LeMessurier), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence, and Impact (Guyatt), McMaster University, Hamilton, Ont
| | - Oscar Niragira
- Centre for Communicable Diseases and Infection Control (Traversy, Varsaneux, Weekes, Avey, Niragira, Gervais, Rodin), Public Health Agency of Canada; Department of Family Medicine (LeMessurier) and School of Epidemiology and Public Health (LeMessurier), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence, and Impact (Guyatt), McMaster University, Hamilton, Ont
| | - Robert Gervais
- Centre for Communicable Diseases and Infection Control (Traversy, Varsaneux, Weekes, Avey, Niragira, Gervais, Rodin), Public Health Agency of Canada; Department of Family Medicine (LeMessurier) and School of Epidemiology and Public Health (LeMessurier), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence, and Impact (Guyatt), McMaster University, Hamilton, Ont
| | - Gordon Guyatt
- Centre for Communicable Diseases and Infection Control (Traversy, Varsaneux, Weekes, Avey, Niragira, Gervais, Rodin), Public Health Agency of Canada; Department of Family Medicine (LeMessurier) and School of Epidemiology and Public Health (LeMessurier), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence, and Impact (Guyatt), McMaster University, Hamilton, Ont
| | - Rachel Rodin
- Centre for Communicable Diseases and Infection Control (Traversy, Varsaneux, Weekes, Avey, Niragira, Gervais, Rodin), Public Health Agency of Canada; Department of Family Medicine (LeMessurier) and School of Epidemiology and Public Health (LeMessurier), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence, and Impact (Guyatt), McMaster University, Hamilton, Ont.
| |
Collapse
|
22
|
Vora N, Saunders J. Use of antiretroviral drugs to prevent the transmission and acquisition of HIV. Br J Hosp Med (Lond) 2019; 79:544-545. [PMID: 30290745 DOI: 10.12968/hmed.2018.79.10.544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Nina Vora
- Academic Clinical Fellow, UCL Centre for Clinical Research in Infection and Sexual Health, University College London, Mortimer Market Centre, Central and North West London NHS Foundation Trust, London WC1E 6JB
| | - John Saunders
- Consultant in Genitourinary and HIV Medicine, UCL Centre for Clinical Research in Infection and Sexual Health, University College London, Mortimer Market Centre, Central and North West London NHS Foundation Trust, London
| |
Collapse
|
23
|
Farel CE, Dennis AM. Why Everyone (Almost) with HIV Needs to Be on Treatment: A Review of the Critical Data. Infect Dis Clin North Am 2019; 33:663-679. [PMID: 31248703 DOI: 10.1016/j.idc.2019.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Since 2014, a consensus of landmark studies has justified starting antiretroviral therapy (ART) regardless of CD4 count. The evidence for immediate and universal ART is strong, clearly showing individual and population-level benefits, and is supported by all major guidelines groups. Altogether, improvements in ART and recognition of its clinical and epidemiologic benefits justify near-universal ART, preferably as soon after the diagnosis of human immunodeficiency virus (HIV) as possible. Case-based discussions provide a framework to explore the evidence behind the current recommendation for ART for all HIV-positive persons and specific scenarios are discussed in which ART initiation may be delayed.
Collapse
Affiliation(s)
- Claire E Farel
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Road, CB# 7030, Chapel Hill, NC 27599, USA.
| | - Ann M Dennis
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Road, CB# 7030, Chapel Hill, NC 27599, USA
| |
Collapse
|
24
|
Rendina HJ, Parsons JT. Factors associated with perceived accuracy of the Undetectable = Untransmittable slogan among men who have sex with men: Implications for messaging scale-up and implementation. J Int AIDS Soc 2019; 21. [PMID: 29334178 PMCID: PMC5810313 DOI: 10.1002/jia2.25055] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 12/19/2017] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Recent research has shown high efficacy of HIV treatment for reducing the risk of HIV transmission to sexual partners. As the efficacy of treatment as prevention (TasP) has proliferated, a new messaging campaign, Undetectable = Untransmittable, has been gaining popularity. The purpose of this paper was to assess factors associated with the perceived accuracy of this TasP messaging strategy among a large and diverse sample of gay, bisexual, and other men who have sex with men (GBMSM) in order to inform subsequent efforts at large-scale and implementation of the HIV prevention message. METHODS We conducted a nationwide survey of GBMSM in the U.S. recruited from an online social networking site and a mobile sexual networking app. We analysed data from 12,222 GBMSM separately by HIV status to examine sociodemographic and behavioural factors associated with ratings of the accuracy of the Undetectable = Untransmittable message, which included the option to indicate not understanding what "undetectable" meant. RESULTS Among HIV-negative and unknown men, multivariable linear regression indicated that being on pre-exposure prophylaxis (PrEP), identifying as gay or queer (versus bisexual or straight), recent serodiscordant condomless anal sex (CAS), testing every six months or more often, less concern about sexually transmitted infection (STI) infection, and lower perceived risk of HIV infection were the factors with the largest independent effect on rating the Undetectable = Untransmittable statement as more accurate. Fewer factors emerged as associated with accuracy ratings among HIV-positive participants-reporting an undetectable viral load, a lifetime acquired immune deficiency syndrome (AIDS) diagnosis, and lower concern about STI infection were the factors most strongly associated with rating the statement as more accurate. CONCLUSIONS The findings of the current study highlight variability in the perceived accuracy of the Undetectable = Untransmittable message, suggesting potential subgroups who might benefit from targeted educational campaigns, perhaps broadcast utilizing sexual networking apps. Numerous factors, particularly among HIV-negative and unknown GBMSM, were associated with rating the message as more accurate. In particular, being on PrEP and testing regularly were two of the variables most strongly associated with higher accuracy ratings among HIV-negative GBMSM, suggesting HIV prevention services as potential points of intervention for increasing HIV knowledge and decreasing HIV stigma.
Collapse
Affiliation(s)
- H Jonathon Rendina
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA.,Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY, USA.,The Center for HIV Educational Studies & Training (CHEST), Hunter College of the City University of New York (CUNY), New York, NY, USA
| | - Jeffrey T Parsons
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA.,Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY, USA.,The Center for HIV Educational Studies & Training (CHEST), Hunter College of the City University of New York (CUNY), New York, NY, USA
| |
Collapse
|
25
|
Aggarwal R, Pham M, Dillingham R, McManus KA. Expanded HIV Clinic-Based Mental Health Care Services: Association With Viral Suppression. Open Forum Infect Dis 2019; 6:ofz146. [PMID: 31041347 PMCID: PMC6483129 DOI: 10.1093/ofid/ofz146] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 03/15/2019] [Indexed: 11/13/2022] Open
Abstract
Background An academic Ryan White HIV/AIDS Program clinic increased co-located mental health care (MH) services in 2013. The study objectives were to characterize the changing demographics of the people living with HIV (PLWH) who initiated MH and to determine MH initiation's association with HIV outcomes. Methods The cohort included PLWH who received clinic-based MH services from 2012 to 2014. Cohorts A and B initiated MH before or during 2012 and during 2013-2014, respectively. Demographics were compared for the 2 cohorts, and for Cohort B, pre/post-MH initiation clinical outcomes were compared. Results Compared with Cohort A (n = 130), Cohort B (n = 181) had 3 times the participants with CD4 counts <200 (P = .02). One-third of Cohort B had detectable viral loads compared with <20% of Cohort A (P = .01). Cohort B received more substance use diagnoses (P = .005). Pre/post-MH initiation, engagement in care did not change. For Cohort B, MH initiation was associated with increased rates of viral suppression. For those who were prescribed antiretroviral therapy more than 1 year before MH initiation, participants who were older and nonblack were more likely to achieve viral suppression. Conclusions PLWH who gained access to MH in 2013-2014 were more likely to have lower CD4 counts and detectable viral loads. Engagement in care did not increase with initiation of MH, but initiation of MH was associated with higher rates of viral suppression. Younger and minority patients may not have benefited as much from increased access to co-located MH and substance use services.
Collapse
Affiliation(s)
- Raina Aggarwal
- School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Michael Pham
- School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Rebecca Dillingham
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia
| | - Kathleen A McManus
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia.,Center for Health Policy, University of Virginia, Charlottesville, Virginia
| |
Collapse
|
26
|
McManus H, Callander D, Donovan B, Russell DB, O'Connor CC, Davies SC, Lewis DA, Hellard ME, Chen MY, Petoumenos K, Varma R, Cogle A, Boyd MA, Grulich A, Pollard J, Medland N, Fairley CK, Guy RJ. Early initiation of antiretroviral therapy for people newly diagnosed with HIV infection in Australia: trends and predictors, 2004-2015. Med J Aust 2019; 210:269-275. [PMID: 30773651 DOI: 10.5694/mja2.50006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 11/01/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine trends in and predictors of early treatment for people newly diagnosed with human immunodeficiency virus (HIV) infection in Australia. DESIGN, SETTING Retrospective cohort analysis of routinely collected longitudinal data from 44 sexual health clinics participating in the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance (ACCESS) program. PARTICIPANTS Patients diagnosed with HIV infections, January 2004 - June 2015. MAIN OUTCOME MEASURES Commencement of antiretroviral therapy within 6 months of HIV diagnosis (early treatment); demographic, clinical, and risk group characteristics of patients associated with early treatment; trends in early treatment, by CD4+ cell count at diagnosis. RESULTS 917 people were diagnosed with HIV infections, their median age was 34 years (interquartile range [IQR]: 27-43 years), and 841 (92%) were men; the median CD4+ cell count at diagnosis was 510 cells/μL (IQR, 350-674 cells/μL). The proportion of patients who received early treatment increased from 17% (15 patients) in 2004-06 to 20% (34 patients) in 2007-09, 34% (95 patients) in 2010-12, and 53% (197 patients) in 2013-15 (trend, P < 0.001). The probability of early treatment, which increased with time, was higher for patients with lower CD4+ cell counts and higher viral loads at diagnosis. CONCLUSIONS The proportion of people newly diagnosed with HIV in sexual health clinics in Australia who received treatment within 6 months of diagnosis increased from 17% to 53% during 2004-2015, reflecting changes in the CD4+ cell count threshold in treatment guidelines. Nevertheless, further strategies are needed to maximise the benefits of treatment to prevent viral transmission and morbidity.
Collapse
Affiliation(s)
- Hamish McManus
- The Kirby Institute, University of New South Wales, Sydney, NSW
| | | | - Basil Donovan
- The Kirby Institute, University of New South Wales, Sydney, NSW.,Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW
| | | | | | - Stephen C Davies
- Northern Sydney Sexual Health Service, Royal North Shore Hospital, Sydney, NSW
| | - David A Lewis
- Western Sydney Sexual Health Centre, University of Sydney, Sydney
| | | | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC
| | | | - Rick Varma
- The Kirby Institute, University of New South Wales, Sydney, NSW.,Sydney Sexual Health Centre, South Eastern Sydney Local Health District, Sydney, NSW
| | - Aaron Cogle
- National Association of People with HIV Australia, Melbourne, NSW
| | - Mark Alastair Boyd
- University of Adelaide, Adelaide, SA.,Lyell McEwin Hospital, Adelaide, SA
| | - Andrew Grulich
- The Kirby Institute, University of New South Wales, Sydney, NSW
| | | | - Nick Medland
- The Kirby Institute, University of New South Wales, Sydney, NSW.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC.,Melbourne Sexual Health Centre, Monash University Central Clinical School, Melbourne, VIC
| | - Rebecca J Guy
- The Kirby Institute, University of New South Wales, Sydney, NSW
| |
Collapse
|
27
|
Population size and self-reported characteristics and sexual preferences of men-who-have-sex-with-men (MSM) in Germany based on social network data. PLoS One 2019; 14:e0212175. [PMID: 30763362 PMCID: PMC6375596 DOI: 10.1371/journal.pone.0212175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 01/22/2019] [Indexed: 11/19/2022] Open
Abstract
Background In the absence of detailed information about the population size and behaviour data of men-who-have-sex-with-men (MSM), the estimation of prevalence rates of sexually transmitted infections (STIs) and the design of public health interventions become difficult. The aim of the present study is to estimate the lower boundary of age-specific population sizes and retrieve self-reported information from this population. Methods We used publicly accessible data from a large online dating and social network website for MSM in Germany to retrieve data on the age and regional distribution of profiles. The profiles were also stratified by their information on the preferred position during anal intercourse, safer sex, and sexual identity. Results A total of 464,873 user profiles correspond to an average 15.2 profiles per 1,000 male inhabitants in Germany, varying between 7.6 and 45.6 across federal states. Although the information on the absolute numbers for different age groups is limited by the search engine, age-specific relative frequencies were found to increase from 12.9 in the age group of 18 to 20 year olds to 24.6 profiles per 1,000 male inhabitants in the 28 to 30 year olds. The data shows age-specific trends for safer sex with an increasing easiness of reporting “never” engaging in safer sex or stating that safer sex “needs discussion” with increasing age. Around one third of profile owners stated to be versatile with respect to the preferred position in anal intercourse. All other options (“only bottom”, “more bottom”, “only top”, “more top”) were preferred equally likely by roughly 10% of profile owners, respectively. Conclusions Online social network or dating sites can provide some information about specific populations in the absence of other data sources. The presented results are the first to report age-specific rates of MSM per 1,000 male inhabitants in Germany and may be useful to estimate age-specific prevalence or incidence rates as well as to inform health promotion activities and modelling studies for MSM in Germany.
Collapse
|
28
|
Philpot SP, Prestage G, Ellard J, Grulich AE, Bavinton BR. How Do Gay Serodiscordant Couples in Sydney, Australia Negotiate Undetectable Viral Load for HIV Prevention? AIDS Behav 2018; 22:3981-3990. [PMID: 30105588 DOI: 10.1007/s10461-018-2247-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Many gay Australian serodiscordant couples are currently relying on an HIV-positive partner's undetectable viral load (UVL) to practice condomless sex. For these couples, preventing HIV is often considered a mutual responsibility, yet they lack a formally endorsed strategy that helps them navigate 'UVL for prevention' (UfP) as a couple. Drawing on interviews with 21 Australian gay men representing 15 serodiscordant couples, we explored 'the couple' within serodiscordant HIV prevention. In learning to rely on UfP, couples were initially apprehensive as they navigated unfamiliar territory, but their concerns faded over time. Confidence in UfP was facilitated by repeated condomless sex without transmission, consistent test results, and being in a couple framed by trust, commitment, and familiarity. Gay male serodiscordant couples should be encouraged to negotiate clear, spoken 'viral load agreements' (VLAs) if they choose to rely on UfP.
Collapse
Affiliation(s)
- Steven P Philpot
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, Sydney, NSW, 2052, Australia.
| | - Garrett Prestage
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Jeanne Ellard
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Andrew E Grulich
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Benjamin R Bavinton
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| |
Collapse
|
29
|
Bavinton BR, Pinto AN, Phanuphak N, Grinsztejn B, Prestage GP, Zablotska-Manos IB, Jin F, Fairley CK, Moore R, Roth N, Bloch M, Pell C, McNulty AM, Baker D, Hoy J, Tee BK, Templeton DJ, Cooper DA, Emery S, Kelleher A, Grulich AE, Grulich AE, Zablotska-Manos IB, Prestage GP, Jin F, Bavinton BR, Grinsztejn B, Phanuphak N, Cooper DA, Kelleher A, Emery S, Fairley CK, Wilson D, Koelsch KK, Triffitt K, Doong N, Baker D, Bloch M, Templeton DJ, McNulty A, Pell C, Hoy J, Tee BK, Moore R, Roth N, Orth D, Pinto AN. Viral suppression and HIV transmission in serodiscordant male couples: an international, prospective, observational, cohort study. THE LANCET HIV 2018. [DOI: 10.1016/s2352-3018(18)30132-2 10.1016/s2352-3018(18)30261-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
|
30
|
Bavinton BR, Pinto AN, Phanuphak N, Grinsztejn B, Prestage GP, Zablotska-Manos IB, Jin F, Fairley CK, Moore R, Roth N, Bloch M, Pell C, McNulty AM, Baker D, Hoy J, Tee BK, Templeton DJ, Cooper DA, Emery S, Kelleher A, Grulich AE. Viral suppression and HIV transmission in serodiscordant male couples: an international, prospective, observational, cohort study. Lancet HIV 2018; 5:e438-e447. [PMID: 30025681 DOI: 10.1016/s2352-3018(18)30132-2] [Citation(s) in RCA: 293] [Impact Index Per Article: 48.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/11/2018] [Accepted: 06/01/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Evidence on viral load and HIV transmission risk in HIV-serodiscordant male homosexual couples is limited to one published study. We calculated transmission rates in couples reporting condomless anal intercourse (CLAI), when HIV-positive partners were virally suppressed, and daily pre-exposure prophylaxis (PrEP) was not used by HIV-negative partners. METHODS In the Opposites Attract observational cohort study, serodiscordant male homosexual couples were recruited from 13 clinics in Australia, one in Brazil, and one in Thailand. At study visits, HIV-negative partners provided information on sexual behaviour and were tested for HIV and sexually transmitted infections; HIV-positive partners had HIV viral load tests, CD4 cell count, and sexually transmitted infection tests done. Viral suppression was defined as less than 200 copies per mL. Linked within-couple HIV transmissions were identified with phylogenetic analysis. Incidence was calculated per couple-year of follow-up, focusing on periods with CLAI, no use of daily PrEP, and viral suppression. One-sided upper 95% CI limits for HIV transmission rates were calculated with exact Poisson methods. FINDINGS From May 8, 2012, to March 31, 2016, in Australia, and May 7, 2014, to March 31, 2016, in Brazil and Thailand, 358 couples were enrolled. 343 couples had at least one follow-up visit and were followed up for 588·4 couple-years. 258 (75%) of 343 HIV-positive partners had viral loads consistently less than 200 copies per mL and 115 (34%) of 343 HIV-negative partners used daily PrEP during follow-up. 253 (74%) of 343 couples reported within-couple CLAI during follow-up, with a total of 16 800 CLAI acts. Three new HIV infections occurred but none were phylogenetically linked. There were 232·2 couple-years of follow-up and 12 447 CLAI acts in periods when CLAI was reported, HIV-positive partners were virally suppressed, and HIV-negative partners did not use daily PrEP, resulting in an upper CI limit of 1·59 per 100 couple-years of follow-up for transmission rate. INTERPRETATION HIV treatment as prevention is effective in men who have sex with men. Increasing HIV testing and linking to immediate treatment is an important strategy in HIV prevention in homosexual men. FUNDING National Health and Medical Research Council; amfAR, The Foundation for AIDS Research; ViiV Healthcare; and Gilead Sciences.
Collapse
Affiliation(s)
| | | | | | - Beatriz Grinsztejn
- Evandro Chagas Institute of Clinical Research, FIOCRUZ, Rio de Janeiro, Brazil
| | | | | | - Fengyi Jin
- The Kirby Institute, Sydney, NSW, Australia
| | - Christopher K Fairley
- Monash University, Melbourne, VIC, Australia; Melbourne Sexual Health Centre, Melbourne, VIC, Australia
| | - Richard Moore
- Northside Clinic, Melbourne, VIC, Australia; The Alfred Hospital, Melbourne, VIC, Australia
| | - Norman Roth
- Prahran Market Clinic, Melbourne, VIC, Australia
| | - Mark Bloch
- Holdsworth House Medical Practice, Sydney, NSW, Australia
| | | | - Anna M McNulty
- University of New South Wales, Sydney, NSW, Australia; Sydney Sexual Health Centre, Sydney, NSW, Australia
| | | | - Jennifer Hoy
- Monash University, Melbourne, VIC, Australia; The Alfred Hospital, Melbourne, VIC, Australia
| | | | - David J Templeton
- The Kirby Institute, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; RPA Sexual Health, Sydney, NSW, Australia
| | - David A Cooper
- The Kirby Institute, Sydney, NSW, Australia; Immunology B Ambulatory Clinic, St Vincent's Hospital, Sydney, NSW, Australia
| | - Sean Emery
- The Kirby Institute, Sydney, NSW, Australia; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | | | | | | |
Collapse
|
31
|
Abstract
This article interrogates the mainstream healthcare narrative that frames human immunodeficiency virus (HIV) as a chronic disease, and triangulates it with the lived experiences of people with HIV in Singapore. It also examines how HIV patients reconstruct their identities after the diagnosis of HIV. Four HIV patients (two males and two females) were interviewed in depth by an experienced medical social worker. Findings revealed that even as the illness trajectory of HIV has shifted from a terminal condition to a chronic one, living with HIV continues to be fraught with difficulty as society, especially in the Asian context, perceives HIV with much fear and disapproval. The participants had an overwhelming sense of shame when they were initially diagnosed with HIV and they had to reconstruct a liveable identity by containing the shroud of shame, reinforcing their normative identities and constructing new ones. These strategies help them to keep their shame at bay. This paper also unpacks nuanced insights of shame experienced by Chinese HIV patients in an Asian city dominated by Confucian values.
Collapse
Affiliation(s)
- Lai Peng Ho
- a Communicable Disease Centre , Tan Tock Seng Hospital , Singapore
| | - Esther C L Goh
- b Department of Social Work , National University of Singapore , Singapore
| |
Collapse
|
32
|
Mayer KH, Maloney KM, Levine K, King D, Grasso C, Krakower DS, Rosenberg ES, Boswell SL. Sociodemographic and Clinical Factors Associated With Increasing Bacterial Sexually Transmitted Infection Diagnoses in Men Who Have Sex With Men Accessing Care at a Boston Community Health Center (2005-2015). Open Forum Infect Dis 2017; 4:ofx214. [PMID: 29181421 PMCID: PMC5695616 DOI: 10.1093/ofid/ofx214] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 09/28/2017] [Indexed: 11/14/2022] Open
Abstract
Background The reasons why bacterial sexually transmitted infections (BSTIs) are increasing in US men who have sex with men (MSM) have not been fully characterized. Methods An open cohort of MSM accessing medical care at a Boston community health center was used to assess secular trends in BSTI diagnoses. Frequency of infection and the estimated population size were used to calculate diagnosis rates. Poisson models were fit for multivariable analyses. Results Between 2005 and 2015, 19 232 men had at least 1 clinic visit. Most (72.4%) were white; 6.0% were black, and 6.1% were Latino. Almost half had documented self-report of identifying as gay (42.6%) or bisexual (3.2%). Most had private health insurance (61.7%); 5.4% had Medicare, 4.6% had Medicaid, and 8.4% reported no insurance. Between 2005 and 2015, BSTI diagnoses increased more than 8-fold. In 2015, of 1319 men who were diagnosed with at least 1 BSTI; 291 were diagnosed with syphilis, 554 with gonorrhea (51.4% rectal, 31.0% urogenital), and 679 with chlamydia (69.1% rectal, 34.3% urogenital). In 2015, 22.7% of BSTIs were diagnosed among HIV-infected patients (15.4% of the clinic population), and 32.8% of BSTIs were diagnosed among HIV-uninfected patients using pre-exposure prophylaxis (PrEP; 10.1% of all men in care). In multivariable analyses, age 18 to 24 years, being HIV-infected, using PrEP, being nonwhite, or reporting Medicaid or not reporting having private insurance or Medicare were independently associated with being diagnosed with a new BSTI. Conclusions Over the past decade, BSTI diagnosis rates increased in HIV-infected and uninfected MSM, with disproportionate increases in PrEP users, racial and ethnic minority MSM, those aged 25 to 34 years, and those without stable health insurance, warranting focused education, screening, and accessible services for these key subpopulations.
Collapse
Affiliation(s)
- Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, Massachusetts.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Kevin M Maloney
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kenneth Levine
- The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Dana King
- The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Chris Grasso
- The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Douglas S Krakower
- The Fenway Institute, Fenway Health, Boston, Massachusetts.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Eli S Rosenberg
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Stephen L Boswell
- The Fenway Institute, Fenway Health, Boston, Massachusetts.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
33
|
Tang H, Wu Z, Mao Y, Cepeda J, Morano J. Risk Factor Associated with Negative Spouse HIV Seroconversion among Sero-Different Couples: A Nested Case-Control Retrospective Survey Study in 30 Counties in Rural China. PLoS One 2016; 11:e0164761. [PMID: 27741292 PMCID: PMC5065194 DOI: 10.1371/journal.pone.0164761] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 10/02/2016] [Indexed: 11/19/2022] Open
Abstract
Background Antiretroviral therapy (ART) and condom use have been proven to reduce the risk of sexual transmission of human immunodeficiency virus (HIV) among HIV sero-different couples, but its full implementation remains a challenge. This study aims to assess HIV seroconversion rate of HIV-negative spouse and its associated risk factors among HIV sero-different couples in rural China. Methods An open cohort of HIV sero-different couples enrolled in 30 counties in China between October 1, 2010, and September 30, 2012, and followed-up to December 31, 2012, was constructed retrospectively. A nested case-control study of risk factors of HIV seroconversion among sero-different couples was conducted in April and May of 2013, based on the open cohort. Sero-different couples with the HIV-negative spouse seroconverting at least 3 months after the previous negative diagnosis during cohort observation period were labeled as “case couples”. The “control couples” were selected randomly from the same cohort that did not have the HIV-negative spouse seroconversion during the same period. The “case couples” and “control couples” were matched on gender, age, and region of residence. Sexual behaviors among HIV sero-different couples before and after the index spouses notifying their HIV infection status to their HIV-negative spouses were collected via face-to-face interview. Univariate and multivariate logistic regression models were used to assess factors associated with HIV seroconversion among HIV sero-different couples. Results Of 4481 HIV sero-different couples, a total of 53 seroconversions were observed within 5218 person-years of follow-up. The incidence rate was 1.02 (95%CI: 0.76–1.33) per 100 person-years. Forty “case couples” confirmed HIV-negative spouse seroconversions infected via marital sexual transmission, were matched to 80 “control couples”. Of the 120 couples, 81(67.5%) were receiving ART, and 70 (58.3%) reported consistently used condoms during intercourse after the index spouse was diagnosed HIV infection. Multivariate conditional logistic regression analysis showed that the desire to conceive a child (OR = 5.18, 95% CI: 1.19–22.58) significantly increased the odds of HIV seroconversion. Protective factors of spousal HIV seroconversion were currently receiving ART (OR = 0.09, 95% CI: 0.01–0.67) and consistent condom use (OR = 0.05, 95% CI: 0.01–0.28). Conclusions Intention to conceive a child is the most important risk factor for HIV seroconversion among sero-different couples. Specific efforts on scientific use of ART to assist sero-different couples to achieve their wish to conceive a healthy child are needed to minimize the risk of HIV transmission.
Collapse
Affiliation(s)
- Houlin Tang
- Division of Integration and Evaluation, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail: ,
| | - Yurong Mao
- Division of Integration and Evaluation, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Javier Cepeda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Jamie Morano
- Division of Infectious Diseases and International Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida, United States of America
| |
Collapse
|
34
|
Günthard HF, Saag MS, Benson CA, del Rio C, Eron JJ, Gallant JE, Hoy JF, Mugavero MJ, Sax PE, Thompson MA, Gandhi RT, Landovitz RJ, Smith DM, Jacobsen DM, Volberding PA. Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2016 Recommendations of the International Antiviral Society-USA Panel. JAMA 2016; 316:191-210. [PMID: 27404187 PMCID: PMC5012643 DOI: 10.1001/jama.2016.8900] [Citation(s) in RCA: 477] [Impact Index Per Article: 59.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
IMPORTANCE New data and therapeutic options warrant updated recommendations for the use of antiretroviral drugs (ARVs) to treat or to prevent HIV infection in adults. OBJECTIVE To provide updated recommendations for the use of antiretroviral therapy in adults (aged ≥18 years) with established HIV infection, including when to start treatment, initial regimens, and changing regimens, along with recommendations for using ARVs for preventing HIV among those at risk, including preexposure and postexposure prophylaxis. EVIDENCE REVIEW A panel of experts in HIV research and patient care convened by the International Antiviral Society-USA reviewed data published in peer-reviewed journals, presented by regulatory agencies, or presented as conference abstracts at peer-reviewed scientific conferences since the 2014 report, for new data or evidence that would change previous recommendations or their ratings. Comprehensive literature searches were conducted in the PubMed and EMBASE databases through April 2016. Recommendations were by consensus, and each recommendation was rated by strength and quality of the evidence. FINDINGS Newer data support the widely accepted recommendation that antiretroviral therapy should be started in all individuals with HIV infection with detectable viremia regardless of CD4 cell count. Recommended optimal initial regimens for most patients are 2 nucleoside reverse transcriptase inhibitors (NRTIs) plus an integrase strand transfer inhibitor (InSTI). Other effective regimens include nonnucleoside reverse transcriptase inhibitors or boosted protease inhibitors with 2 NRTIs. Recommendations for special populations and in the settings of opportunistic infections and concomitant conditions are provided. Reasons for switching therapy include convenience, tolerability, simplification, anticipation of potential new drug interactions, pregnancy or plans for pregnancy, elimination of food restrictions, virologic failure, or drug toxicities. Laboratory assessments are recommended before treatment, and monitoring during treatment is recommended to assess response, adverse effects, and adherence. Approaches are recommended to improve linkage to and retention in care are provided. Daily tenofovir disoproxil fumarate/emtricitabine is recommended for use as preexposure prophylaxis to prevent HIV infection in persons at high risk. When indicated, postexposure prophylaxis should be started as soon as possible after exposure. CONCLUSIONS AND RELEVANCE Antiretroviral agents remain the cornerstone of HIV treatment and prevention. All HIV-infected individuals with detectable plasma virus should receive treatment with recommended initial regimens consisting of an InSTI plus 2 NRTIs. Preexposure prophylaxis should be considered as part of an HIV prevention strategy for at-risk individuals. When used effectively, currently available ARVs can sustain HIV suppression and can prevent new HIV infection. With these treatment regimens, survival rates among HIV-infected adults who are retained in care can approach those of uninfected adults.
Collapse
Affiliation(s)
- Huldrych F Günthard
- University Hospital Zurich and Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | | | | | - Carlos del Rio
- Emory University Rollins School of Public Health and School of Medicine, Atlanta, Georgia
| | - Joseph J Eron
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill
| | | | - Jennifer F Hoy
- Alfred Hospital and Monash University, Melbourne, Australia
| | | | - Paul E Sax
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Rajesh T Gandhi
- Massachusetts General Hospital and Harvard Medical School, Boston
| | | | | | | | | |
Collapse
|
35
|
Homosexual men in HIV serodiscordant relationships: implications for HIV treatment as prevention research. J Int AIDS Soc 2015; 18:19884. [PMID: 26015387 PMCID: PMC4733160 DOI: 10.7448/ias.18.1.19884] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 03/05/2015] [Accepted: 04/22/2015] [Indexed: 02/05/2023] Open
Abstract
Introduction Studies in heterosexual HIV serodiscordant couples have provided critical evidence on the role of HIV treatments in reducing HIV transmission risk. However, there are limited data regarding the effect of treatment on HIV transmission in homosexual male couples. We examined features of male homosexual HIV serodiscordant relationships that may impact upon the design of HIV treatment and transmission studies. Methods Data were from a prospective cohort study of HIV-negative homosexual men in Sydney, Australia. Men were followed up with six-monthly interviews and annual testing for HIV. Characteristics of men in HIV serodiscordant and seroconcordant relationships at baseline were compared, and a longitudinal analysis performed of rate of relationship break-up and of HIV incidence. Results At baseline, 5.5% of participants (n=79) had an HIV-positive partner. Most (80.8%) of these relationships were non-monogamous, and 36.7% of men reported recent unprotected anal intercourse (UAI) with casual partners. The rate of relationship break-up was 29.5 per 100 person-years. Half of men in serodiscordant relationships (49.4%) reported recent UAI with their regular partners. HIV incidence was 2.2 per 100 person-years. It was substantially higher in relationships of less than one year's duration (6.1 per 100 person-years) and in men who reported unprotected receptive anal intercourse with ejaculation with their regular partners (15.5 per 100 person-years). Conclusions Levels of HIV transmission risk and incidence were high, particularly in early relationships. Rates of relationship break-up were high. These data suggest that studies of HIV treatments and transmission in homosexual serodiscordant couples should focus on early relationships so as not to underestimate risk, and sample sizes must allow for high rates of relationship break-up.
Collapse
|
36
|
Jin F, Prestage GP, Mao L, Poynten IM, Templeton DJ, Grulich AE, Zablotska I. "Any Condomless Anal Intercourse" is No Longer an Accurate Measure of HIV Sexual risk Behavior in Gay and Other Men Who have Sex with Men. Front Immunol 2015; 6:86. [PMID: 25774158 PMCID: PMC4343002 DOI: 10.3389/fimmu.2015.00086] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 02/13/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Condomless anal intercourse (CLAI) has long been recognized as the primary mode of sexual transmission of HIV in gay and other men who have sex with men (MSM). A variety of measures of CLAI have been commonly used in behavioral surveillance for HIV risk and to forecast trends in HIV infection. However, gay and other MSM's sexual practices changed as the understanding of disease and treatment options advance. In the present paper, we argue that summary measures such as "any CLAI" do not accurately measure HIV sexual risk behavior. METHODS Participants were 1,427 HIV-negative men from the Health in Men cohort study run from 2001 to 2007 in Sydney, Australia, with six-monthly interviews. At each interview, detailed quantitative data on the number of episodes of insertive and receptive CLAI in the last 6 months were collected, separated by partner type (regular vs. casual) and partners' HIV status (negative, positive, and HIV status unknown). RESULTS A total of 228,064 episodes of CLAI were reported during the study period with a mean of 44 episodes per year per participant (median: 14). The great majority of CLAI episodes were with a regular partner (92.6%), most of them with HIV-negative regular partners (84.8%). Participants were more likely to engage in insertive CLAI with casual than with regular partners (66.7 vs. 55.3% of all acts of CLAI with each partner type, p < 0.001). Men were more likely to report CLAI in the receptive position with HIV-negative and HIV status unknown partners than with HIV-positive partners (p < 0.001 for both regular and casual partners). CONCLUSION Gay and other MSM engaging in CLAI demonstrate clear patterns of HIV risk reduction behavior. As HIV prevention enters the era of antiretroviral-based biomedical approach, using all forms of CLAI indiscriminately as a measure of HIV behavioral risk is not helpful in understanding the current drivers of HIV transmission in the community.
Collapse
Affiliation(s)
- Fengyi Jin
- The Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | - Garrett P. Prestage
- The Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | - Limin Mao
- The Centre for Social Research in Health, University of New South Wales, Kensington, NSW, Australia
| | - I. Mary Poynten
- The Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | - David J. Templeton
- The Kirby Institute, University of New South Wales, Kensington, NSW, Australia
- RPA Sexual Health, Sydney Local Health District, Sydney, NSW, Australia
| | - Andrew E. Grulich
- The Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | - Iryna Zablotska
- The Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| |
Collapse
|