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Antiretroviral Medication Adherence and Amplified HIV Transmission Risk Among Sexually Active HIV-Infected Individuals in Three Diverse International Settings

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Abstract

Successful biomedical prevention/treatment-as-prevention (TasP) requires identifying individuals at greatest risk for transmitting HIV, including those with antiretroviral therapy (ART) nonadherence and/or ‘amplified HIV transmission risk,’ defined as condomless sex with HIV-uninfected/unknown-status partners when infectious (i.e., with detectable viremia or STI diagnosis according to Swiss criteria for infectiousness). This study recruited sexually-active, HIV-infected patients in Brazil, Thailand, and Zambia to examine correlates of ART nonadherence and ‘amplified HIV transmission risk’. Lower alcohol use (OR = .71, p < .01) and higher health-related quality of life (OR = 1.10, p < .01) were associated with greater odds of ART adherence over and above region. Of those with viral load data available (in Brazil and Thailand only), 40 % met Swiss criteria for infectiousness, and 29 % had ‘amplified HIV transmission risk.’ MSM had almost three-fold (OR = 2.89, p < .001) increased odds of ‘amplified HIV transmission risk’ (vs. heterosexual men) over and above region. TasP efforts should consider psychosocial and contextual needs, particularly among MSM with detectable viremia.

Resumen

Prevención biomédica exitosa/tratamiento como prevención (TasP por sus ciclas en inglés) requiere identificar individuos con mayor riesgo de transmitir el VIH, incluyendo aquellos con terapia antiretroviral (ART) no adherente y/o con ‘riesgo de transmisión amplificada de HIV’ definida como sexo sin condón con parejas no infectadas/estado desconocido cuando infecciosos (es decir, viremia detectable o diagnóstico de las ITS según criterios Suizos de contagiosidad). Este estudio reclutó pacientes sexualmente activos, infectados por el VIH en Brasil, Tailandia y Zambia para examinar la correlación de falta de adherencia al ART y ‘el riesgo de transmisión del VIH amplificado’. Bajo consumo de alcohol (OR = .71, p < .01) y una calidad de vida superior en términos de salud (OR = 1.10, p < .01) se asociaron con mayor probabilidad de adherencia del ART más allá de la región. Aquellos con datos de carga viral (en Brasil y Tailandia), 40 % cumplieron los criterios suizos de ‘contagiosidad‘, y el 29 % tenía ‘riesgo de transmisión amplificado’. Hombres que tienen sexo con hombres tuvieron casi triple (OR = 2.89, p < .001) probabilidades de ‘riesgo de transmisión amplificado’ (contrario a los hombres heterosexuales) más allá de la región. Los esfuerzos de TasP deben considerar las necesidades psicosociales y contextuales, especialmente entre hombres que tienen sexo con hombres con viremia detectable.

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Acknowledgments

HPTN 063 was funded by the Division of AIDS (DAIDS), National Institute of Allergy and Infectious Disease (NIAID), National Institute on Drug Abuse (NIDA), and the National Institute of Mental Health (NIMH) under Cooperative Agreement # UM1AI068619. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or The HIV Prevention Trials Network. The authors would also like to acknowledge the staff at the HPTN 063 study sites for their contributions to the study. Additionally, Dr. Magidson’s work on this manuscript was supported by NIH Grant T32MH093310, and Dr. Safren was supported by NIH Grant K24MH094214. Dr. Mayer and Dr. Safren were also supported by the Harvard University Center for AIDS Research (HU CFAR) NIH P30AI060354. This manuscript was supported by consultation from other members of the HU CFAR Social and Behavioral Sciences Core.

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Authors and Affiliations

  1. Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA

    Jessica F. Magidson & Matthew J. Mimiaga

  2. Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Xin Li & James P. Hughes

  3. Harvard School of Public Health, Boston, MA, USA

    Matthew J. Mimiaga

  4. The Fenway Institute, Fenway Health, Boston, MA, USA

    Matthew J. Mimiaga, Kenneth H. Mayer & Steven A. Safren

  5. FHI360, Durham, NC, USA

    Ayana T. Moore

  6. Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand

    Kriengkrai Srithanaviboonchai

  7. Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Kriengkrai Srithanaviboonchai

  8. Instituto de Pesquisa Clinica Evandro Chagas, Rio de Janeiro, Brazil

    Ruth Khalili Friedman

  9. Centre for Infectious Disease Research in Zambia, Lusaka, Zambia

    Mohammad Limbada

  10. University of Washington, Seattle, WA, USA

    James P. Hughes

  11. Division of Infectious Diseases, Departments of Pathology and Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA

    Vanessa Cummings & Charlotte A. Gaydos

  12. National Institute of Allergy and Infectious Disease (NIAID), Bethesda, MD, USA

    Vanessa Elharrar

  13. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    David Celentano

  14. Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA, USA

    Kenneth H. Mayer

  15. Department of Psychology, University of Miami, Coral Gables, FL, USA

    Steven A. Safren

Authors
  1. Jessica F. Magidson
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  2. Xin Li
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  3. Matthew J. Mimiaga
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  4. Ayana T. Moore
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  5. Kriengkrai Srithanaviboonchai
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  6. Ruth Khalili Friedman
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  7. Mohammad Limbada
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  8. James P. Hughes
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  9. Vanessa Cummings
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  10. Charlotte A. Gaydos
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  11. Vanessa Elharrar
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  12. David Celentano
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  13. Kenneth H. Mayer
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  14. Steven A. Safren
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Correspondence to Jessica F. Magidson.

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Magidson, J.F., Li, X., Mimiaga, M.J. et al. Antiretroviral Medication Adherence and Amplified HIV Transmission Risk Among Sexually Active HIV-Infected Individuals in Three Diverse International Settings. AIDS Behav 20, 699–709 (2016). https://doi.org/10.1007/s10461-015-1142-7

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  • DOI: https://doi.org/10.1007/s10461-015-1142-7

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