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HIV sexual transmission risks in the context of clinical care: a prospective study of behavioural correlates of HIV suppression in a community sample, Atlanta, GA, USA.

Kalichman SC, Cherry C, Kalichman MO, Washington C, Grebler T, Merely C, Welles B, Pellowski J, Kegler C - J Int AIDS Soc (2015)

Bottom Line: In addition, 15% of participants with suppressed HIV had recent STI symptoms/diagnoses, indicating significant risks for sexual infectiousness despite their HIV suppression in blood plasma.Overall, 38% of participants were at risk for elevated sexual infectiousness and just as many engaged in unprotected sexual intercourse with non-HIV-infected partners.Implementation strategies for using HIV treatments as HIV prevention requires enhanced behavioural interventions that extend beyond ART to address substance use and sexual health that will otherwise undermine the potential preventive impact of early ART.

View Article: PubMed Central - PubMed

Affiliation: Department of Psychology and Center for Health Intervention and Prevention, University of Connecticut, Storrs, CT, USA; seth.k@uconn.edu.

ABSTRACT

Introduction: Antiretroviral therapy (ART) improves the health of people living with HIV and has the potential to reduce HIV infectiousness, thereby preventing HIV transmission. However, the success of ART for HIV prevention hinges on sustained ART adherence and avoiding sexually transmitted infections (STI).

Objectives: To determine the sexual behaviours and HIV transmission risks of individuals with suppressed and unsuppressed HIV replication (i.e., viral load).

Methods: Assessed HIV sexual transmission risks among individuals with clinically determined suppressed and unsuppressed HIV. Participants were 760 men and 280 women living with HIV in Atlanta, GA, USA, who completed behavioural assessments, 28-daily prospective sexual behaviour diaries, one-month prospective unannounced pill counts for ART adherence, urine screening for illicit drug use and medical record chart abstraction for HIV viral load.

Results: Individuals with unsuppressed HIV demonstrated a constellation of behavioural risks for transmitting HIV to uninfected sex partners that included symptoms of STI and substance use. In addition, 15% of participants with suppressed HIV had recent STI symptoms/diagnoses, indicating significant risks for sexual infectiousness despite their HIV suppression in blood plasma. Overall, 38% of participants were at risk for elevated sexual infectiousness and just as many engaged in unprotected sexual intercourse with non-HIV-infected partners.

Conclusions: Implementation strategies for using HIV treatments as HIV prevention requires enhanced behavioural interventions that extend beyond ART to address substance use and sexual health that will otherwise undermine the potential preventive impact of early ART.

No MeSH data available.


Related in: MedlinePlus

(a) Percent of participants receiving ART, ART adherent and achieving HIV suppression and (b) sexual HIV transmission risks among individuals with suppressed and unsuppressed HIV.
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Figure 0001: (a) Percent of participants receiving ART, ART adherent and achieving HIV suppression and (b) sexual HIV transmission risks among individuals with suppressed and unsuppressed HIV.

Mentions: Figure 1a summarizes the proportions of the sample that were being treated with ART, at least 85% adherent and viral suppressed, indicating that one in four participants were likely sexually infectious based on blood plasma viral load alone. Figure 1b shows the differences in recent STI symptoms/diagnoses, and engaging in sexual intercourse without condoms in HIV concordant and non-concordant relationships, and condomless sex with any partners. Three multivariable logistic regression models tested the independent association of HIV viral suppression and HIV transmission risks from: (a) having recent STI diagnosis/STI symptoms, (b) engaging in any condomless intercourse and (c) engaging in condomless sex with HIV non-concordant partners. All models are controlled for participant age, years since testing HIV positive, gender, transsexual identity, income, employment status, CD4 cell count, being treated with ART and knowledge of most recent viral load. Results of adjusted models showed that poorer HIV suppression was related to having recent STI, adjusted odds ratio (OR)=1.59, p<0.01, 95% confidence interval (CI) 1.12–2.25; engaging in more condomless intercourse over the prospective 28 days, adj OR=1.06, p<0.05, 95% CI 1.01–1.10 and engaging in more condomless sex with non-concordant partners, adj OR=1.06, p=0.08, 0.99–1.12.


HIV sexual transmission risks in the context of clinical care: a prospective study of behavioural correlates of HIV suppression in a community sample, Atlanta, GA, USA.

Kalichman SC, Cherry C, Kalichman MO, Washington C, Grebler T, Merely C, Welles B, Pellowski J, Kegler C - J Int AIDS Soc (2015)

(a) Percent of participants receiving ART, ART adherent and achieving HIV suppression and (b) sexual HIV transmission risks among individuals with suppressed and unsuppressed HIV.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4528077&req=5

Figure 0001: (a) Percent of participants receiving ART, ART adherent and achieving HIV suppression and (b) sexual HIV transmission risks among individuals with suppressed and unsuppressed HIV.
Mentions: Figure 1a summarizes the proportions of the sample that were being treated with ART, at least 85% adherent and viral suppressed, indicating that one in four participants were likely sexually infectious based on blood plasma viral load alone. Figure 1b shows the differences in recent STI symptoms/diagnoses, and engaging in sexual intercourse without condoms in HIV concordant and non-concordant relationships, and condomless sex with any partners. Three multivariable logistic regression models tested the independent association of HIV viral suppression and HIV transmission risks from: (a) having recent STI diagnosis/STI symptoms, (b) engaging in any condomless intercourse and (c) engaging in condomless sex with HIV non-concordant partners. All models are controlled for participant age, years since testing HIV positive, gender, transsexual identity, income, employment status, CD4 cell count, being treated with ART and knowledge of most recent viral load. Results of adjusted models showed that poorer HIV suppression was related to having recent STI, adjusted odds ratio (OR)=1.59, p<0.01, 95% confidence interval (CI) 1.12–2.25; engaging in more condomless intercourse over the prospective 28 days, adj OR=1.06, p<0.05, 95% CI 1.01–1.10 and engaging in more condomless sex with non-concordant partners, adj OR=1.06, p=0.08, 0.99–1.12.

Bottom Line: In addition, 15% of participants with suppressed HIV had recent STI symptoms/diagnoses, indicating significant risks for sexual infectiousness despite their HIV suppression in blood plasma.Overall, 38% of participants were at risk for elevated sexual infectiousness and just as many engaged in unprotected sexual intercourse with non-HIV-infected partners.Implementation strategies for using HIV treatments as HIV prevention requires enhanced behavioural interventions that extend beyond ART to address substance use and sexual health that will otherwise undermine the potential preventive impact of early ART.

View Article: PubMed Central - PubMed

Affiliation: Department of Psychology and Center for Health Intervention and Prevention, University of Connecticut, Storrs, CT, USA; seth.k@uconn.edu.

ABSTRACT

Introduction: Antiretroviral therapy (ART) improves the health of people living with HIV and has the potential to reduce HIV infectiousness, thereby preventing HIV transmission. However, the success of ART for HIV prevention hinges on sustained ART adherence and avoiding sexually transmitted infections (STI).

Objectives: To determine the sexual behaviours and HIV transmission risks of individuals with suppressed and unsuppressed HIV replication (i.e., viral load).

Methods: Assessed HIV sexual transmission risks among individuals with clinically determined suppressed and unsuppressed HIV. Participants were 760 men and 280 women living with HIV in Atlanta, GA, USA, who completed behavioural assessments, 28-daily prospective sexual behaviour diaries, one-month prospective unannounced pill counts for ART adherence, urine screening for illicit drug use and medical record chart abstraction for HIV viral load.

Results: Individuals with unsuppressed HIV demonstrated a constellation of behavioural risks for transmitting HIV to uninfected sex partners that included symptoms of STI and substance use. In addition, 15% of participants with suppressed HIV had recent STI symptoms/diagnoses, indicating significant risks for sexual infectiousness despite their HIV suppression in blood plasma. Overall, 38% of participants were at risk for elevated sexual infectiousness and just as many engaged in unprotected sexual intercourse with non-HIV-infected partners.

Conclusions: Implementation strategies for using HIV treatments as HIV prevention requires enhanced behavioural interventions that extend beyond ART to address substance use and sexual health that will otherwise undermine the potential preventive impact of early ART.

No MeSH data available.


Related in: MedlinePlus