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

Abstract

Evidence showed preventive impacts of the highly active antiretroviral therapy (HAART) on the Human Immunodeficiency Virus (HIV) transmission amomg heterosexual population, however, that is of deficit among men who have sex with men (MSM). The aim was to systematically examine the efficacy of HAART on HIV transmission and the association between the HAART initiation and unprotected anal intercourse (UAI) in MSM population. Three electronic databases were fully searched for articles published in peer-reviewed journals between 1996 and 2017. Of 1616 identified articles, fifteen articles were eligible for meta-analyses. The summary incidence rate (IR) of HIV was 6.63/100 person-year (95%CI 2.06-11.20/100 person-year)(p = 0.004). The pooled per-contact rate (PCR) of HIV was 0.42% (95% CI 0.21-0.63%)(p < 0.05). The HAART initiation (vs non-HAART) was not associated with engaging in UAI, with odds ratio (OR) 1.09 (95% CI 0.90-1.34)(p > 0.05). In the stratified analysis, participants with no less than 6 months recall period was slightly more likely to engage in UAI (OR 1.32; 95% CI 1.01-1.74)(p < 0.05). It indicated that HAART has potential efficacy on reducing infectivity of HIV positive individuals in anal intercourses. The relationship between the HAART initiation and UAI was not significant and may be influenced by some social-demographic factors. Consistent condom use and education on safe sex among MSM are crucial. Globally, over 78 million people were infected with HIV. The prevalence of people living with HIV was 36.7 million 1. Among men who have sex with men (MSM), the average percentage of HIV prevalence ranged between 6% (the Asia and Pacific region) and 15% (the western and central Africa region) 2. In young (under 25) MSM, around 4.2% of the population was infected with HIV 2. Although there is a trend of reduction of HIV incidence in the general population in most countries, it showed an upward trend among MSM 2,3. Two Australian studies predicted that, for homosexual males, the mean number of homosexual partners was 11 in the past 1 year 4 , compared with heterosexual men, which was about 1.5 5. Theoretically, with high possibility of partner change rate, the MSM is regarded as the core group in the transmission of sexual transmitted diseases (STIs) including HIV 6. Also, the MSM-population is supposed to be the risk group in the pattern of HIV transmission. A UNAIDS report estimated that the risk of HIV acquisition in MSM was 19 times higher than that in the heterosexual population 2. Compared with different patterns of sexual intercourses, the risk of HIV transmission was the highest via the UAI 7. The multiple combination of antiretroviral drugs (ARVs), highly active antiretroviral therapy (HAART), was proved to successfully suppress the HIV virus in blood 8. A landmark randomized clinic trail (RCT) HPTN 052 demonstrated that the HAART reduced individuals' risk of HIV-1 transmission via sex with condoms by 96% between heterosexual sero-discordant partners 9. Similar results were found in an observatio...

Craft of Co-encapsulation in Nanomedicine: A Struggle To Achieve Synergy through Reciprocity

“…Co-encapsulated nanocarriers have provided fresh opportunities for improved drug delivery in antiviral therapy, although the published research tends to gravitate toward anti-HIV therapy (Table ). Such co-encapsulated nanocarriers typically contain multiple antiretrovirals (ARVs) to achieve a system for combination antiretroviral therapy or highly active antiretroviral therapy . The motive behind co-encapsulating ARVs is to inhibit the reproductive cycle of HIV at various stages and achieve synergism (Figure ).…”

“…Such co-encapsulated nanocarriers typically contain multiple antiretrovirals (ARVs) to achieve a system for combination antiretroviral therapy 199 or highly active antiretroviral therapy. 200 The motive behind co-encapsulating ARVs is to inhibit the reproductive cycle of HIV at various stages 201 and achieve synergism ( Figure 6 ). Other desirable goals are to improve bioavailability and penetration into tissues while addressing toxicity, untoward drug interactions, and emergence of resistance.…”