Frequency and predictors of estimated HIV transmissions and bacterial STI acquisition among HIV‐positive patients in HIV care across three continents

Abstract

IntroductionSuccessful global treatment as prevention (TasP) requires identifying HIV-positive individuals at high risk for transmitting HIV, and having impact via potential infections averted. This study estimated the frequency and predictors of numbers of HIV transmissions and bacterial sexually transmitted infection (STI) acquisition among sexually active HIV-positive individuals in care from three representative global settings.MethodsHIV-positive individuals (n=749), including heterosexual men, heterosexual women and men who have sex with men (MSM) in HIV care, were recruited from Chiang Mai (Thailand), Rio De Janeiro (Brazil) and Lusaka (Zambia). Participants were assessed on HIV and STI sexual transmission risk variables, psychosocial characteristics and bacterial STIs at enrolment and quarterly for 12 months (covering 15 months). Estimated numbers of HIV transmissions per person were calculated using reported numbers of partners and sex acts together with estimates of HIV transmissibility, accounting for ART treatment and condom use.ResultsAn estimated 3.81 (standard error, (SE)=0.63) HIV transmissions occurred for every 100 participants over the 15 months, which decreased over time. The highest rate was 19.50 (SE=1.68) for every 100 MSM in Brazil. In a multivariable model, country×risk group interactions emerged: in Brazil, MSM had 2.85 (95% CI=1.45, 4.25, p<0.0001) more estimated transmissions than heterosexual men and 3.37 (95% CI=2.01, 4.74, p<0.0001) more than heterosexual women over the 15 months. For MSM and heterosexual women, the combined 12-month STI incidence rate for the sample was 22.4% (95% CI=18.1%, 27.3%; incidence deemed negligible in heterosexual men). In the multivariable model, MSM had 12.3 times greater odds (95% CI=4.44, 33.98) of acquiring an STI than women, but this was not significant in Brazil. Higher alcohol use on the Alcohol Use Disorders Identification Test (OR=1.04, 95% CI=1.01, 1.08) was also significantly associated with increased STI incidence. In bivariate models for both HIV transmissions and STI incidence, higher depressive symptoms were significant predictors.ConclusionsThese data help to estimate the potential number of HIV infections transmitted and bacterial STIs acquired over time in patients established in care, a group typically considered at lower transmission risk, and found substantial numbers of estimated HIV transmissions. These findings provide an approach for evaluating the impact (in phase 2 studies) and potentially cost-effectiveness of global TasP efforts.

The Role of Religious Service Attendance, Psychosocial and Behavioral Determinants of Antiretroviral Therapy (ART) Adherence: Results from HPTN 063 Cohort Study

“…Specifically, in Brazil and in a combined-country model, the highest frequencies of religious service attendance (compared to never/rarely attending) were associated with lower likelihood of ART adherence as alcohol problems increased. Substance use, including problematic alcohol use, was related to lower ART adherence (63,64) and higher STI incidence and HIV transmission risk in the HPTN 063 cohort (43). In one independent sample of persons in HIV outpatient care in Rio Grande, Brazil, the prevalence of unhealthy alcohol use prevalence among people living with HIV was 29% (65).…”

“…HPTN 063 was an observational, longitudinal year-long, multisite cohort study of HIVinfected individuals in care in Brazil (Rio De Janeiro), Thailand (Chiang Mai), and Zambia (Lusaka) (43). HPTN 063 was designed as a preparedness study to acquire data to develop interventions to decrease sexual transmission by people living with HIV, and to determine whether the same interventions could be effectively deployed in patients from multiple risk groups and cultural settings.…”

“…HPTN 063 was designed as a preparedness study to acquire data to develop interventions to decrease sexual transmission by people living with HIV, and to determine whether the same interventions could be effectively deployed in patients from multiple risk groups and cultural settings. Participants aged 18 years and older were recruited if they were infected with HIV, engaged in HIV care (defined as at least two visits at a clinic or hospital in the past nine months), or met criteria for sexual risk behavior in the past 12 months (e.g., history of condomless insertive penile, receptive vaginal, or anal intercourse with a sexual partner of unknown HIV status), including evidence of acquisition of a sexually transmitted infection in the past 12 months or anal intercourse without a condom (43). Details of the study design, recruitment, and enrollment have been described in depth (41,43).…”

“…Participants aged 18 years and older were recruited if they were infected with HIV, engaged in HIV care (defined as at least two visits at a clinic or hospital in the past nine months), or met criteria for sexual risk behavior in the past 12 months (e.g., history of condomless insertive penile, receptive vaginal, or anal intercourse with a sexual partner of unknown HIV status), including evidence of acquisition of a sexually transmitted infection in the past 12 months or anal intercourse without a condom (43). Details of the study design, recruitment, and enrollment have been described in depth (41,43). A total of N=749 participants were recruited across the three sites: Brazil: 263, Thailand: 300, and Zambia: 186.…”

A meta-analysis of the efficacy of HAART on HIV transmission and its impact on sexual risk behaviours among men who have sex with men

“…In general, the pooled IR (6.63/100 person-year, p < 0.05)) in our meta-analysis was within the range of the incidence rate of HIV (1.2 to 14.4/100 person-year) in MSM population reported by WHO 24 . The overall weighted IR was highly influenced by the number contributed from Brazil 25 . This extreme data indicated that the risk of HIV transmission among MSM may be different within distinct regions.…”