Abstract
Acute/early HIV infection is a period of heightened HIV transmission and a window of opportunity for intervention to prevent onward disease transmission. The NIMH Multisite Acute HIV Infection (AHI) Study was an exploratory initiative aimed at determining the feasibility of recruiting persons with AHI into research, assessing their psychosocial and behavioral characteristics, and examining short-term changes in these characteristics. This paper reports on lessons learned in the study, including: (1) the need to establish the cost-effectiveness of AHI testing; (2) challenges to identifying persons with AHI; (3) the need to increase awareness of acute-phase HIV transmission risks; (4) determining the goals of behavioral interventions following AHI diagnosis; and (5) the need for “rapid response” public health systems that can move quickly enough to intervene while persons are still in the AHI stage. There are untapped opportunities for behavioral and medical science collaborations in these areas that could reduce the incidence of HIV infection.
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Atkinson, J. H., Higgins, J., Vigil, O., Dubrow, R., Remien, R. H., Steward, W. T., Casey, C. Y., Sikkema, K. J., Correale, J., Ake, C., McCutchan, J. A., Morin, S. F., & Grant, I. (2009). Psychiatric context of acute/early HIV infection. The NIMH multisite acute HIV infection study: IV. AIDS and Behavior. doi:10.1007/s10461-009-9585-3.
Busch, M. P., & Hecht, F. M. (2005). Nucleic acid amplification testing for diagnosis of acute HIV infection: Has the time come? AIDS (London, England), 19, 1323–1325. doi:10.1097/01.aids.0000180103.65640.d8.
Crepaz, N., & Marks, G. (2002). Towards an understanding of sexual risk behavior in people living with HIV: A review of social, psychosocial, and medical findings. AIDS (London, England), 16, 135–149. doi:10.1097/00002030-200201250-00002.
Hall, H. I., Song, R., Rhodes, P., Prejean, J., An, Q., Lee, L. M., et al. (2008). Estimation of HIV incidence in the United States. Journal of the American Medical Association, 300, 520–528. doi:10.1001/jama.300.5.520.
Hecht, F. M., Collier, W. L., Little, S., Markowitz, M., Margolick, J., Kilby, J. M., et al. (2006). A multicenter observational study of the potential benefits of initiating combination antiretroviral therapy during acute HIV infection. The Journal of Infectious Diseases, 194, 725–733. doi:10.1086/506616.
Kalichman, S. C., Rompa, D., & Cage, M. (2000). Sexually transmitted infections among HIV seropositive men and women. Sexually Transmitted Infections, 76, 350–354. doi:10.1136/sti.76.5.350.
Kalichman, S. C., Rompa, D., Cage, M., DeFonzo, K., Simpson, D., Austin, J., et al. (2001). Effectiveness of an intervention to reduce HIV transmission risks in HIV-positive people. American Journal of Preventive Medicine, 21, 84–92. doi:10.1016/S0749-3797(01)00324-5.
Kerndt, P. R., Dubrow, R., Aynalem, G., Mayer, K. H., Beckwith, C., Remien, R. H., Truong, H. M., Uniyal, A., Chien, M., Brooks, R. A., Vigil, O. R., Steward, W. T., Merson, M., Rotheram-Borus, M. J., & Morin, S. F. (2009). Strategies used in the detection of acute/early HIV infections. The NIMH multisite acute HIV infection study: I. AIDS and Behavior. doi:10.1007/s10461-009-9580-8.
Panel on Antiretroviral Guidelines for Adults and Adolescents. (2008). Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services, Nov 3, 2008. Available at http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf. Accessed January 30, 2009.
Patterson, K. B., Leone, P. A., Fiscus, S. A., Kuruc, J., McCoy, S. I., Wolf, L., et al. (2007). Frequent detection of acute HIV infection in pregnant women. AIDS (London, England), 21, 2303–2308. doi:10.1097/QAD.0b013e3282f155da.
Pilcher, C. D., Eron, J. J., Galvin, S., Gay, C., & Cohen, M. S. (2004a). Acute HIV revisited: New opportunities for treatment and prevention. The Journal of Clinical Investigation, 113, 937–945.
Pilcher, C. D., Tien, H. C., Eron, J. J., Vernazza, P. L., Lev, S. Y., Stewart, P. W., et al. (2004b). Brief but efficient: Acute HIV infection and the sexual transmission of HIV. The Journal of Infectious Diseases, 189, 1785–1792. doi:10.1086/386333.
Pilcher, C. D., Fiscus, S. A., Nguyen, T. Q., Foust, E., Wolf, L., Williams, D., et al. (2005). Detection of acute infections during HIV testing in North Carolina. The New England Journal of Medicine, 352, 1873–1883. doi:10.1056/NEJMoa042291.
Quinn, T. C., Wawer, M. J., Sewankambo, N., Serwadda, D., Li, C., Wabwire-Mangen, F., et al. (2000). Viral load and heterosexual transmission of human immunodeficiency virus type 1: Rakai Project Study Group. The New England Journal of Medicine, 342, 921–929. doi:10.1056/NEJM200003303421303.
Remien, R. H., Higgins, J.A., Correale, J., Bauermeister, J., Dubrow, R., Bradley, M., Steward, W. T., Seal, D. W., Sikkema, K. J., Kerndt, P. R., Mayer, K. H., Truong, H. M., Casey, C. Y., Ehrhardt, A. A., & Morin, S. F. (2009). Lack of understanding of acute HIV infection among newly-infected persons—implications for prevention and public health. The NIMH multisite acute HIV infection study: II. AIDS and Behavior. doi:10.1007/s10461-009-9581-7.
Rotheram-Borus, M. J., Lee, M. B., Murphy, D. A., Futterman, D., Duan, N., Birnbaum, J. M., et al. (2001a). Efficacy of a preventive intervention for youths living with HIV. American Journal of Public Health, 91, 400–405. doi:10.2105/AJPH.91.3.400.
Rotheram-Borus, M. J., Lee, M., Zhou, S., O’Hara, P., Birnbaum, J. M., Swendeman, D., et al. (2001b). Variation in health and risk behaviors among youth living with HIV. AIDS Education and Prevention, 13, 42–54. doi:10.1521/aeap.13.1.42.18923.
Shargi, N., Bosch, R. J., Mayer, K., Essex, M., & Seage, G. R. (2005). The development and utility of a clinical algorithm to predict early HIV-1 infection. Journal of Acquired Immune Deficiency Syndromes, 40, 472–478. doi:10.1097/01.qai.0000164246.49098.47.
Stekler, J., Collier, D. C., Holmes, K. K., & Golden, M. R. (2006). Primary HIV infection education knowledge and attitudes of HIV-negative men who have sex with men attending a public health sexually transmitted disease clinic. Journal of Acquire Immune Deficiency Syndromes, 42, 123–126. doi:10.1097/01.qai.0000218357.82970.67.
Steward, W. T., Remien, R. H., Higgins, J.A., Dubrow, R., Pinkerton, S. D., Sikkema, K. J., Truong, H. M., Johnson, M. O., Hirsch, J., Brooks, R.A., & Morin, S. F. (2009). Behavior change following diagnosis with acute/early HIV infection—a move to serosorting with other HIV-infected individuals. The NIMH multisite acute HIV infection study: III. AIDS and Behavior. doi:10.1007/s10461-009-9582-6.
Sudarshi, D., Pao, D., Murphy, G., Parry, J., & Fisher, M. (2008). Missed opportunities for diagnosing primary HIV infections. Sexually Transmitted Infections, 84, 14–16. doi:10.1136/sti.2007.026963.
Team, Healthy. Living. Project. (2007). Effects of a behavioral intervention to reduce risk of transmission among people living with HIV: The healthy living project randomized controlled study. Journal of Acquired Immune Deficiency Syndromes, 44, 213–221. doi:10.1097/QAI.0b013e31802c0cae.
Vanable, P. A., Ostrow, D. G., McKirnan, D. J., Taywaditep, K. J., & Hope, B. A. (2000). Impact of combination therapies on HIV risk perceptions and sexual risk among HIV-positive and HIV-negative gay and bisexual men. Health Psychology, 19, 134–145.
WHO and UNAIDS. (2007). AIDS epidemic update. Geneva: Joint United Nations Programme on HIV/AIDS and World Health Organization.
Acknowledgments
Primary funding for this study was provided by the National Institute of Mental Health as supplements to the following AIDS Research Centers: P30MH062246, Center for AIDS Prevention Studies, University of California San Francisco; P30MH043520, HIV Center for Clinical and Behavioral Research, New York State Psychiatric Institute and Columbia University; P30MH062512, HIV Neurobehavioral Research Center, University of California San Diego; P30MH052776, Center for AIDS Intervention Research, Medical College of Wisconsin; P30MH058107, Center for HIV Identification, Prevention and Treatment Services, University of California Los Angeles; and P30MH062294, Center for Interdisciplinary Research on AIDS, Yale University. Additional funding was provided by: P30AI42853, Lifespan/Tufts/Brown Center for AIDS Research and AI43638, Acute Infection and Early Disease Research Program, University of California San Diego. Complete details about funding, the study Steering Committee, co-investigators, collaborating scientists, and project staff are presented in the first paper of this series (Kerndt et al 2009).
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Kelly, J.A., Morin, S.F., Remien, R.H. et al. Lessons Learned about Behavioral Science and Acute/Early HIV Infection. The NIMH Multisite Acute HIV Infection Study: V. AIDS Behav 13, 1068–1074 (2009). https://doi.org/10.1007/s10461-009-9579-1
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DOI: https://doi.org/10.1007/s10461-009-9579-1