Characterising HIV transmission risk among US patients with HIV in care: a cross-sectional study of sexual risk behaviour among individuals with viral load above 1500 copies/mL

Abstract

Objectives Viral load and sexual risk behaviour contribute to HIV transmission risk. High HIV viral loads present greater transmission risk than transient viral “blips” above an undetectable level. This paper therefore characterises sexual risk behaviour among HIV patients in care with viral loads >1500 copies/ml and associated demographic characteristics. Methods This cross-sectional study was conducted at six HIV outpatient clinics in the United States. The study sample comprises 1315 HIV patients with a recent viral load >1500 copies/ml. This study sample was drawn from a larger sample of individuals with a recent viral load >1000 copies/ml who completed a computer-assisted self-interview (CASI) regarding sexual risk practices in the last two months. The study sample was 32% heterosexual men, 38% men who have sex with men (MSM), and 30% women. Results Ninety percent of the sample had their viral load assay within 60 days of the CASI. Thirty-seven percent reported being sexually active (vaginal or anal intercourse) in the last two months. Most of the sexually active participants reported always using condoms (56.9%) or limiting condomless sex to seroconcordant partners (serosorting; 29.2% overall and 42.9% among MSM). Among sexually active participants who reported condomless anal or vaginal sex with an at-risk partner (14%), most had viral loads >10,000 copies/ml (62%). Conclusions A relatively small number of HIV patients in care with viral loads above 1500 copies/ml reported concurrent sexual transmission risk behaviours. Most of the individuals in this small group had markedly elevated viral loads, increasing the probability of transmission. Directing interventions to patients in care with high viral loads and concurrent risk behaviour could strengthen HIV prevention and reduce HIV infections.

Socio-economic condition and lack of virological suppression among adults and adolescents receiving antiretroviral therapy in Ethiopia

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HIV seroconcordance among heterosexual couples in rural KwaZulu‐Natal, South Africa: a population‐based analysis

“…One potential explanation for higher HIV seroconcordance among HIV‐positive heterosexual couples is that individuals living with HIV may have intentionally chosen partners with the same HIV status. In high‐income settings, several quantitative and qualitative studies have reported that MSM choose seroconcordant partners to reduce the risk of HIV acquisition and transmission , and more likely to do so than heterosexual men and women . Evidence from heterosexual couples in SSA suggests that individuals living with HIV may seek and receive more social support from seroconcordant partners .…”

Syphilis among adult males with a history of male-to-male sexual contact living with diagnosed HIV in New York State (excluding New York City): The challenge of intersecting epidemics

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