Less decrease in risk behaviour from pre-HIV to post-HIV seroconversion among MSM in the combination antiretroviral therapy era compared with the pre-combination antiretroviral therapy era

Heijman, Titia; Geskus, Ronald B.; Davidovich, Udi; Coutinho, Roel A.; Prins, Maria; Stolte, Ineke G.

doi:10.1097/qad.0b013e32834f9d7c

Cited by 46 publications

(48 citation statements)

References 26 publications

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“…Identification of HIV infection during the acute phase of infection provides an opportunity to significantly reduce the risk of HIV transmission by providing education, safer-sex counseling, enrollment in care, and in some cases, initiation of antiretroviral therapy at a time when transmission risk may be greatest (7, 21-23, 39, 47). An accurate diagnosis of acute HIV infection is particularly relevant, as the impact of pre-and posttest counseling on risk behaviors may be eroding (20). Inclusion of the HIV p24 antigen in 4th-generation assays like the HIV Combo assay does allow the detection of some persons with acute HIV infection.…”

Section: Discussionmentioning

confidence: 99%

Cost Savings Associated with Testing of Antibodies, Antigens, and Nucleic Acids for Diagnosis of Acute HIV Infection

et al. 2012

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Efforts to identify all persons infected with HIV in the United States are driven by the hope that early diagnosis will lower risk behaviors and decrease HIV transmission. Identification of HIV-infected people earlier in the course of their infection with HIV antigen/antibody (Ag/Ab) combination assays (4th-generation HIV assays) should help achieve this goal. We compared HIV RNA nucleic acid test (NAT) results to the results of a 4th-generation Ag/Ab assay (Architect HIV Ag/Ab Combo [HIV Combo] assay; Abbott Diagnostics) in 2,744 HIV antibody-negative samples. Fourteen people with acute HIV infection (HIV antibody negative/NAT positive) were identified; the HIV Combo assay detected nine of these individuals and was falsely negative in the remaining five. All five persons missed by the HIV Combo assay were in the stage of exponential increase in plasma virus associated with acute HIV infection (3, 7, 20, 35, 48). In contrast, most acutely infected persons detected by the HIV Combo assay demonstrated either a plateauing or decreasing plasma viral load. The HIV Combo assay also classified as positive five other samples which were negative by NAT. Taken together, the HIV Combo assay had a sensitivity of 73.7% and a specificity of 99.8%. Using published data, we estimated secondary transmission events had HIV infection in these five individuals remained undiagnosed. Screening of our population with NAT cost more than screening with the HIV Combo assay but achieved new diagnoses that we predict resulted in health care savings that far exceed screening costs. These findings support the use of more sensitive assays, like NAT, in HIV screening of populations with a high prevalence of acute HIV infection.

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Section: Discussionmentioning

confidence: 99%

Cost Savings Associated with Testing of Antibodies, Antigens, and Nucleic Acids for Diagnosis of Acute HIV Infection

et al. 2012

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“…Although being diagnosed with HIV has been associated with a significant reduction in sexual risk behavior, 1-3 a substantial minority of PLHIV continue to engage in unprotected sex. [4][5][6][7] Others may decrease sexual risk behavior immediately after diagnosis but show a rebound in these behaviors in subsequent months or years. For example, one study of men who have sex with men (MSM) who were recently infected with HIV found that the percentage of unprotected sex with unknown serostatus partners decreased from 49% at baseline to 25% at 6 months, but then rebounded to 71% at 12 months.…”

Section: Introductionmentioning

confidence: 99%

“…2 Another study that followed trends in sexual behavior pre-and post-HIV diagnosis found a 53% probability of unprotected sex at 1 year after diagnosis, but an increase to 61% 4 years after diagnosis. 5 Ongoing efforts to identify those factors that promote safer sexual behaviors between PLHIV and their partners are needed. Serostatus disclosure is fundamental to our understanding of the experience of HIV as an illness, because of its connection to privacy, ethical responsibility, and its possible function in prevention of disease transmission risk.…”

Section: Introductionmentioning

confidence: 99%

Examining the Role of Serostatus Disclosure on Unprotected Sex Among People Living with HIV

Przybyla

Golin

Widman

et al. 2014

AIDS Patient Care and STDs

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Given the increasing prevalence of HIV, it is important to identify factors associated with safer sex behaviors between people living with HIV and their partners. Utilizing a diverse sample of 242 HIV-infected adults [n = 69 men who have sex with men (MSM); n = 68 men who have sex with women (MSW); n = 105 women who have sex with men (WSM)], we examined the association between serostatus disclosure and unprotected anal or vaginal intercourse (UAVI) and the moderating effect of sexual behavior group on this association. Overall, 88.7% disclosed to their current partner. Approximately 18.8% of MSM, 17.7% of MSW, and 29.5% of WSM reported UAVI. Controlling for age, time since diagnosis, and partner serostatus, we found main effects on UAVI for disclosure and sexual behavior group; specifically, disclosure was inversely related to unprotected sex [AOR = 0.09, 95% CI (0.02, 0.43), p < 0.001], and MSM were less likely to engage in UAVI relative to WSM [AOR = 0.11, 95% CI (0.17, 0.82), p < 0.05]. However, the relationship between disclosure and UAVI was not moderated by sexual behavior group. Future strategies that aim to increase disclosure to partners may consider focusing on its value as a means by which to reduce sexual risk behavior.

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“…27,28 These strategies seem promising in altering the HIV epidemic, but are under debate due to some observations of high-risk populations having low levels of risk perception, 29 and HIV-positive patients increasing risky sexual behaviors in the HAART era. [30][31][32][33] Previous studies have shown that under regular medical care, HIV-positive patients decrease their sexual risk behaviors by 30-55%, 30,33 especially in the initial years following the 158 CHENG ET AL.…”

Section: Discussionmentioning

confidence: 99%

Highly Active Antiretroviral Therapy is Associated with Decreased Incidence of Sexually Transmitted Diseases in a Taiwanese HIV-Positive Population

Cheng

Yang

Hsueh

2013

AIDS Patient Care and STDs

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There are reports of increased sexual risk behaviors in the HIV-positive population since the introduction of highly active antiretroviral therapy (HAART). Little is known about the effects of the case management (CM) program and HAART on sexually transmitted diseases (STDs) in Taiwan. HIV-positive subjects, who visited the outpatient clinics of Taoyuan General Hospital between 2007 and 2010, were enrolled. A total of 574 subjects and 14,462 person-months were reviewed. Incident STDs occurred in 104 (18.1%) subjects, and the incidence rate was 8.6 (95% confidence interval [CI], 7.1-10.5) per 100 person-years (PY). For men who have sex with men (MSM), heterosexual men and women, and injection drug users (IDU), 19.4 per 100 PY(95% CI, 15.7-24.0), 3.5 per 100 PY (95% CI, 1.4-7.3), and 1.1 per 100 PY (95% CI, 0.4-2.4) of STDs were noted, respectively; (MSM versus IDU and MSM versus heterosexual subjects, p < 0.000001; heterosexual subjects versus IDU, p = 0.061). Syphilis (59.6%) was the most common STD. Regular CM and no HAART (hazard ratio, 2.58; 95% CI, 1.14-5.84; p = 0.02) was significantly associated with STDs in MSM. Though this retrospective study might underestimate the incidence of STDs and not draw the conclusion of causality, we concluded that the CM program and HAART are associated with lower acquisition of STDs in the Taiwanese HIV-positive population.

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Less decrease in risk behaviour from pre-HIV to post-HIV seroconversion among MSM in the combination antiretroviral therapy era compared with the pre-combination antiretroviral therapy era

Cited by 46 publications

References 26 publications

Cost Savings Associated with Testing of Antibodies, Antigens, and Nucleic Acids for Diagnosis of Acute HIV Infection

Cost Savings Associated with Testing of Antibodies, Antigens, and Nucleic Acids for Diagnosis of Acute HIV Infection

Examining the Role of Serostatus Disclosure on Unprotected Sex Among People Living with HIV

Highly Active Antiretroviral Therapy is Associated with Decreased Incidence of Sexually Transmitted Diseases in a Taiwanese HIV-Positive Population

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