HIV Transmission in the United States: Considerations of Viral Load, Risk Behavior, and Health Disparities
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Ongoing HIV transmission is related to prevalence, risk behavior and viral load among persons with HIV. We assessed the contribution of these factors to HIV transmission with transmission rate models and data reported to National HIV Surveillance and published rates of risk behavior. We also estimated numbers of persons with risk behaviors and unsuppressed viral load among sexual risk groups. The transmission rate is higher considering risk behavior (18.5 infections per 100 people with HIV) than that attributed to unsuppressed viral load (4.6). Since persons without risk behavior or suppressed viral load presumably transmit HIV at very low rates, transmission can be attributed to a combination of these factors (28.9). Service needs are greatest for MSM; their number with unsuppressed viral load engaging in unprotected discordant sex was 8 times the number of male heterosexuals and more than twice the number of female heterosexuals with high-risk transmission potential. While all persons with HIV need optimal care, treatment as prevention is most relevant when risk behavior is present among persons with unsuppressed HIV viral load.
- Last, JM (1995) A dictionary of epidemiology. Oxford University Press, New York
- Hall, HI, Song, R, Rhodes, P, Prejean, J, An, Q, Lee, LM (2008) Estimation of HIV incidence in the United States. JAMA 300: pp. 520-529 CrossRef
- Prejean, J, Song, R, Hernandez, A, Ziebell, R, Green, T, Walker, F (2011) Estimated HIV incidence in the United States, 2006–2008. PLoS One 6: pp. e17502 CrossRef
- Centers for Disease Control and Prevention. HIV Surveillance Report, 2010. http://www.cdc.gov/hiv/topics/surveillance/resources/reports/ (2012). Accessed 14 Oct 2012.
- Holtgrave, DR, Hall, HI, Rhodes, PH, Wolitski, RJ (2009) Updated annual HIV transmission rates in the United States, 1978–2006. J Acquir Immune Defic Syndr. 50: pp. 236-238 CrossRef
- Holtgrave, DR, Hall, HI, Prejean, J (2012) HIV transmission rates in the United States, 2006–2008. Open AIDS J. 6: pp. 20-22 CrossRef
- Hall, HI, Holtgrave, DR, Maulsby, C (2012) HIV transmission rates from persons living with HIV who are aware and unaware of their infection. AIDS 26: pp. 887-896 CrossRef
- Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR 55: pp. 1-17
- Marks, G, Crepaz, N, Janssen, RS (2006) Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA. AIDS 20: pp. 1447-1450 CrossRef
- Cohen, MS, Muessig, KE, Smith, MK, Powers, K, Kashuba, ADM (2012) Antiviral agents and HIV prevention: controversies, conflicts and consensus. AIDS 26: pp. 1585-1598 CrossRef
- Pinkerton, SD (2011) HIV transmission rate modeling: a primer, review, and extension. AIDS Behav. 16: pp. 791-796 CrossRef
- Freedman M, Mattson C, Johnson C, et al. Medical Monitoring Project, 2009 to 2010. National representative estimates of sexual risk behaviors among HIV + adults receiving medical care: U.S. 19th Conference on retroviruses and opportunistic infections. Seattle, Washington, 2012.
- Millett, GA, Flores, SA, Peterson, JL, Bakeman, R (2007) Explaining disparities in HIV infection among black and white men who have sex with men: a meta-analysis of HIV risk behaviors. AIDS 21: pp. 2083-2091 CrossRef
- Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services, 1–239. 2012. http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf. Accessed 20 April 2012.
- The White House Office of National AIDS Policy. National HIV/AIDS strategy for the United States. 2010. http://www.whitehouse.gov/administration/eop/onap/nhas/. Accessed 20 April 2012.
- Marks, G, Gardner, LI, Craw, J, Giordano, TP, Mugavero, MJ, Keruly, JC (2012) The spectrum of engagement in HIV care: do more than 19 % of HIV-infected persons in the US have undetectable viral load?. Clin Infect Dis. 53: pp. 1168-1169 CrossRef
- Hasse, B, Ledergerber, B, Hirschel, B, Vernazza, P, Glass, TR, Jeannin, A (2010) Frequency and determinants of unprotected sex among HIV-infected persons: the Swiss HIV Cohort Study. Clin Infect Dis. 51: pp. 1314-1322 CrossRef
- Heijman, T, Geskus, RB, Davidovich, U, Coutinho, RA, Prins, M, Stolte, IG (2012) 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. AIDS 26: pp. 489-495 CrossRef
- Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 U.S. dependent areas—2010. HIV Surveillance Supplemental Report 17(No. 3, part A). 2012. http://www.cdc.gov/hiv/topics/surveillance/resources/reports/. Accessed 28 June 2012.
- Holtgrave, DR, Maulsby, C, Wehrmeyer, L, Hall, HI (2012) Behavioral factors in assessing impact of HIV treatment as prevention. AIDS Behav. 16: pp. 1085-1091 CrossRef
- Centers for Disease Control and Prevention. High-impact HIV prevention. 2012. http://www.cdc.gov/hiv/strategy/dhap/pdf/nhas_booklet.pdf. Accessed 20 April 2012.
- National Alliance of State & Territorial AIDS Directors (NASTAD). ADAP Watch. 2012. http://www.nastad.org/Docs/012236_ADAP%20Watch%20update%20-%202.24.12.pdf. Accessed 20 April 2012.
- Vital signs: HIV prevention through care and treatment–United States. MMWR 60: pp. 1618-1623
- Hall, HI, Gray, KM, Tang, T, Li, J, Shouse, L, Mermin, J (2012) Retention in care of adults and adolescents living with HIV in 13 U.S. areas. J Acquir Immune Defic Syndr. 60: pp. 77-82 CrossRef
- Centers for Disease Control and Prevention. Compendium of evidence-based HIV behavioral interventions: risk reduction chapter. 2012. http://www.cdc.gov/hiv/topics/research/prs/compendium-evidence-based-interventions.htm. Accessed 31 Dec 2012.
- HIV Transmission in the United States: Considerations of Viral Load, Risk Behavior, and Health Disparities
AIDS and Behavior
Volume 17, Issue 5 , pp 1632-1636
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- HIV transmission
- Men who have sex with men
- Industry Sectors
- Author Affiliations
- 1. Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control & Prevention, 1600 Clifton Road NE, MS E-47, Atlanta, GA, 30333, USA
- 2. Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- 3. ICF International, Atlanta, GA, USA