“It comes altogether as one:” perceptions of analytical treatment interruptions and partner protections among racial, ethnic, sex and gender diverse HIV serodifferent couples in the United States

Abstract

Background Most HIV cure-related studies involve interrupting antiretroviral treatment to assess the efficacy of pharmacologic interventions – also known as analytical treatment interruptions (ATIs). ATIs imply the risk of passing HIV to sexual partners due to the loss of undetectable HIV status. There has been a notable lack of attention paid to perceptions of ATIs among racial, ethnic, sex and gender minorities, and HIV serodifferent couples. These populations are among those most impacted by HIV in the United States. Future HIV cure research paradigms should equitably include considerations from these groups. Methods From August – October 2020, we conducted in-depth interviews with 10 racial, ethnic, sex, and gender minority HIV serodifferent couples in geographically diverse regions of the United States to understand their perspectives about ATIs and partner protection measures to prevent secondary HIV transmissions because of participation in ATI studies. We used framework analysis to analyze the qualitative data. Results Of the 10 couples recruited, four identified as a gay couple, two as a gay and bisexual couple, two as a heterosexual couple, one as a gay and queer couple, and one as a queer couple. We found that HIV serodifferent couples in our study viewed ATIs as contradicting HIV treatment adherence messages. Couples expressed discomfort around ATIs in HIV cure research. They were concerned with the return of HIV detectability and worried ATIs might result in secondary HIV transmission. Participants were strongly in favor of using a range of partner protection measures during ATIs that included PrEP, HIV risk reduction counseling, and alternatives for penetrative sex practices. Couples also recommended that sex partners be consulted or involved as part of ATI trials. Conclusions Our findings highlight new potential opportunities and strategies to mitigate risk of HIV transmission during ATIs among key groups historically under-represented in HIV cure research. Findings also underscore the relational aspects of ATI trials. We provide preliminary considerations for planning ATI trials with diverse HIV serodifferent partners. Future studies should continue to explore these issues among other types of partnerships, cultures, and socio-cultural settings.

The Importance of Social Engagement in the Development of an HIV Cure: A Systematic Review of Stakeholder Perspectives

“…The first was potential clinical and medical risks . Perceived risks included side effects, fear of physical pain or uncomfortable procedures, potential ART resistance, permanent harm, and even death [ 22 , 23 , 25 , 29 – 32 , 35 , 38 – 40 , 42 – 44 , 46 – 52 ]. The second barrier was possible social risks , such as concern about transmitting HIV while participating in clinical trials, being treated poorly by the research staff, and privacy concerns [ 22 , 23 , 25 , 30 , 31 , 35 , 41 – 43 , 46 , 48 , 49 , 51 – 56 ].…”

“…Perceived risks included side effects, fear of physical pain or uncomfortable procedures, potential ART resistance, permanent harm, and even death [ 22 , 23 , 25 , 29 – 32 , 35 , 38 – 40 , 42 – 44 , 46 – 52 ]. The second barrier was possible social risks , such as concern about transmitting HIV while participating in clinical trials, being treated poorly by the research staff, and privacy concerns [ 22 , 23 , 25 , 30 , 31 , 35 , 41 – 43 , 46 , 48 , 49 , 51 – 56 ]. Lastly, some barriers were rooted in practical considerations such as fear that research participation would interfere with day-to-day life, needing to take time off from work or family, financial risks, and health insurance concerns [ 23 , 29 , 30 , 35 , 39 , 42 , 44 , 46 , 48 – 53 , 55 , 57 , 58 ].…”

“…The perspectives of key populations (e.g., men who have sex with men, people who inject drugs, transgender people, next of kin, community members, and HIV activists) were most often considered when discussing ATI or end-of-life HIV cure research. Key populations accurately understood the meaning and importance of ATIs and end-of-life HIV cure research [ 22 , 53 , 70 , 71 ].…”

Healthcare Provider Perspectives on HIV Cure Research in Ghana

“…Guidelines for ATI must be adhered to and explained well to both patients and their providers [ 27 , 28 ]. Studies performed in the USA and France show that a majority of patients are willing to undergo ATI [ 18 – 20 , 29 , 30 ], which contrasts with studies performed in Africa [ 23 , 31 ]. It will be interesting to study why these differences exist.…”

HIV cure: an acceptability scientific agenda

“…To evaluate the efficacy of any cure strategy, patients may be asked to stop taking ART while being closely monitored, a process called analytical treatment interruption (ATI) [ 33 ▪▪ , 34 ▪▪ ]. Two types of ATI are used to assess potential cure therapies: time to viral rebound (TVR) studies and viral set-point studies [ 34 ▪▪ ].…”