Annals of Behavioral Medicine

, Volume 42, Issue 1, pp 111–119

Sexual HIV Transmission and Antiretroviral Therapy: A Prospective Cohort Study of Behavioral Risk Factors Among Men and Women Living with HIV/AIDS

  • Seth C. Kalichman
  • Chauncey Cherry
  • Denise White
  • Miche’l Jones
  • Tamar Grebler
  • Moira O. Kalichman
  • Mervi Detorio
  • Angela M. Caliendo
  • Raymond F. Schinazi
Original Article

Abstract

Background

Using antiretroviral therapies for HIV prevention relies on patient adherence and avoidance of co-occurring sexually transmitted infections.

Purpose

The objective of this study is to simultaneously examine HIV treatment adherence and sexual risks for HIV transmission.

Methods

This study is a prospective cohort of 201 men and 55 women diagnosed with HIV/AIDS infection.

Results

A total of 32% men and 39% women engaged in unprotected intercourse with at least one HIV negative or unknown HIV status sex partner over 12 months. Nearly half (46%) of participants with HIV negative or unknown HIV status unprotected sex partners had detectable HIV viral load and were significantly more likely to have contracted a sexually transmitted infection since their HIV diagnosis. Individuals at higher risk for transmitting HIV were also less adherent to antiretroviral therapies.

Conclusions

Programs that aim to use antiretroviral therapies for HIV prevention require careful attention to adherence, sexually transmitted co-infections, and substance use.

Keywords

HIV treatment for prevention Test and treat Sexual risk behavior HIV prevention Positive prevention 

References

  1. 1.
    Kalichman SC. Time to take stock in HIV/AIDS prevention. AIDS Behav, 2008; 12(3): p. 333–4.PubMedCrossRefGoogle Scholar
  2. 2.
    Grant RM, Lama JR, Anderson PL et al., Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. New Eng J Med, 2010; epub ahead of print, November 23, 2010.Google Scholar
  3. 3.
    Kashuba AD, Dyer JR, Kramer L, Raasch R, Eron J, Cohen M. Antiretroviral-drug concentrations in semen: Implications for sexual transmission of human immunodeficiency virus type 1. Antimicrob Agents Chemotherther, 1999;43(8): 1817–26.Google Scholar
  4. 4.
    Donnell D, Baeteb JM, Kiarie J, Thomas K, Stevens W, Cohen C, MCIntyre J, Lingappa J, Celum C. Heterosexual HIV-1 transmission after initiation of antiretroviral therapy: A prospective cohort analysis. Lancet 2010;375:2092–98.PubMedCrossRefGoogle Scholar
  5. 5.
    Quinn TC, Wawer M, Sewankambo MB, Serwadda D, Li C, Wabwire-Mangen F, et al. et al., Viral load and heterosexual transmission of human immunodeficiency virus type 1. New England Journal of Medicine, 2000; 342: 921–929.PubMedCrossRefGoogle Scholar
  6. 6.
    Granich RM, Gilks CF, Dye C, DeCock K, Williams B. Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: A mathematical model. Lancet, 2009; 373(9657):48–57.PubMedCrossRefGoogle Scholar
  7. 7.
    Lima, V.D., Hogg, RS, Montaner JS. Expanding HAART treatment to all currently eligible individuals under the 2008 IAS-USA Guidelines in British Columbia, Canada. PLoS ONE, 2010; 5(6):e10991.PubMedCrossRefGoogle Scholar
  8. 8.
    Vernazza P, Hirschel B, Bernasconi E, Flepp M, HIV-positive individuals without additional sexually transmitted diseases (STD) and on effective anti-retroviral therapy are sexually non-infectious. Bull des médecins suisses 2008; 89:5.Google Scholar
  9. 9.
    Hasse B, Ledergerber B, Hischel B, Vernazza P, Glass T, Jeannin A, et al. Frequency and Determinants of Unprotected Sex among HIV-Infected Persons: The Swiss HIV Cohort Study. Clin Inf Dis, 2010; 51(11):1314–1322.CrossRefGoogle Scholar
  10. 10.
    De Cock KM, et al., Can antiretroviral therapy eliminate HIV transmission? Lancet, 2009;373(9657):7–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Dieffenbach CW, Fauci, A. Universal voluntary testing and treatment for prevention of HIV transmission. JAMA, 2009;301(22):2380–2.PubMedCrossRefGoogle Scholar
  12. 12.
    Garnett GP, Baggaley R. Treating our way out of the HIV pandemic: Could we, would we, should we? Lancet, 2009; 373(9657):9–11.PubMedCrossRefGoogle Scholar
  13. 13.
    Wagner B, Blower S. Costs of eliminating HIV in South Africa have been underestimated. Lancet, 2010;376(9745):953–4.PubMedCrossRefGoogle Scholar
  14. 14.
    Wagner B, Kahn J, Blower S. Should we try to eliminate HIV epidemics by using a ‘Test and Treat’ strategy? AIDS 2010; 24(5):775–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Celum, C., et al., Acyclovir and transmission of HIV-1 from persons infected with HIV-1 and HSV-2. New Eng J Med 2010; 362(5):427–39.PubMedCrossRefGoogle Scholar
  16. 16.
    Cohen MS, et al., Reduction of concentration of HIV-1 in semen after treatment of urethritis: Implications for prevention of sexual transmission of HIV-1. Lancet 1997;349:1868–1873.PubMedCrossRefGoogle Scholar
  17. 17.
    Mills EJ, et al. Adherence to antiretroviral therapy in sub-Saharan Africa and North America: A meta-analysis. JAMA 2006; 296(6):679–90.PubMedCrossRefGoogle Scholar
  18. 18.
    Kalichman SC, Eaton L, Cherry C et al. Sexually transmitted infections and infectiousness beliefs among people living with HIV/AIDS: Implications for HIV treatment as prevention. HIV Med 2010; 11:502–9.PubMedGoogle Scholar
  19. 19.
    Shuper PA, et al., Alcohol as a correlate of unprotected sexual behavior among people living with HIV/AIDS: Review and meta-analysis. AIDS Behav, 2009;13(6): 1021–36.PubMedCrossRefGoogle Scholar
  20. 20.
    Theall KP, et al., Alcohol consumption, ART usage and high-risk sex among women infected with HIV. AIDS Behav, 2007;11(2):205–15.PubMedCrossRefGoogle Scholar
  21. 21.
    Amico KR, et al., The Information-Motivation-Behavioral Skills Model of ART adherence in a deep south HIV+ clinic sample. AIDS Behav 2009;13(1):66–75.PubMedCrossRefGoogle Scholar
  22. 22.
    Hendershot CS, et al. Alcohol use and antiretroviral adherence: Review and meta-analysis. JAIDS, 2009; 52(2):180–202.PubMedCrossRefGoogle Scholar
  23. 23.
    Baliunas D, et al. Alcohol consumption and risk of incident human immunodeficiency virus infection: A meta-analysis. Internat J Public Health 2010; 55(3):159–66.CrossRefGoogle Scholar
  24. 24.
    Kalichman SC, Rompa D. HIV treatment adherence and unprotected sex practices in people receiving antiretroviral therapy. Sex Transm Inf 2003;79(1) 59–61.CrossRefGoogle Scholar
  25. 25.
    Diamond C, et al. Use of and adherence to antiretroviral therapy is associated with decreased sexual risk behavior in HIV clinic patients. JAIDS 2005;39: 211–218.PubMedGoogle Scholar
  26. 26.
    Kalichman SC. Co-occurrence of treatment nonadherence and continued HIV transmission risk behaviors: Implications for positive prevention interventions. Psychosom Med 2008; 70(5):593–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Kalichman SC, Rompa, D, Cage M. Distinguishing between overlapping somatic symptoms of depression and HIV disease in people living with HIV-AIDS. J Nervous Mental Dis 2000;188(10):662–70.PubMedCrossRefGoogle Scholar
  28. 28.
    Baggaley RF, White, RG, Boily MC. HIV transmission risk through anal intercourse: Systematic review, meta-analysis and implications for HIV prevention. Internat J Epid 2010;39(4):1048–63.CrossRefGoogle Scholar
  29. 29.
    Napper LE, Fisher D, Reynolds G, Johnson M. HIV Risk Behavior Self-Report Reliability at Different Recall Periods. AIDS Behav 2010;14:15–61.CrossRefGoogle Scholar
  30. 30.
    Bangsberg DR, et al. Comparing objective measures of adherence to HIV antiretroviral therapy: Electronic medication monitors and unannounced pill counts. AIDS Behav 2001;5:275–281.CrossRefGoogle Scholar
  31. 31.
    Kalichman SC, et al. Monitoring Antiretroviral adherence by unannounced pill counts conducted by telephone: Reliability and criterion-related validity. HIV Clinical Trials 2008;9:298–308.PubMedCrossRefGoogle Scholar
  32. 32.
    Kalichman SC, et al. Adherence to antiretroviral therapy assessed by unannounced pill counts conducted by telephone. J Gen Internal Med 2007; 22: 1003–6.PubMedCrossRefGoogle Scholar
  33. 33.
    Granich R, et al. Highly active antiretroviral treatment as prevention of HIV transmission: Review of scientific evidence and update. Cur Opinions HIV AIDS, 2010; 5(4):298–304.CrossRefGoogle Scholar
  34. 34.
    Engsig F, et al., Risk of high-level viraemia in HIV-infected patients on successful antiretroviral treatment for more than 6 months. HIV Med 2010; 11:457–461.PubMedGoogle Scholar
  35. 35.
    Das M, et al. Decreases in community viral load are accompanied by reductions in new HIV infections in San Francisco. PLoS ONE, 2010; 5(6): e11068.PubMedCrossRefGoogle Scholar
  36. 36.
    Deeks SG, et al. Trends in multidrug treatment failure and subsequent mortality among antiretroviral therapy-experienced patients with HIV infection in North America. Clin Infectious Dis 2009; 49(10):1582–90.PubMedCrossRefGoogle Scholar
  37. 37.
    Parienti JJ, et al. Not all missed doses are the same: Sustained NNRTI treatment interruptions predict HIV rebound at low-to-moderate adherence levels. PLoS ONE 2008; 3(7):e2783.PubMedCrossRefGoogle Scholar
  38. 38.
    Cohen MS, Gay CL. Treatment to prevent transmission of HIV-1. Clinical Infectious Diseases, 2010; 50 Suppl 3:S85-95.PubMedCrossRefGoogle Scholar
  39. 39.
    Johnson LF, Lewis DA. The effect of genital tract infections on HIV-1 shedding in the genital tract: A systematic review and meta-analysis. Sex Transm Dis 2008; 35(11): 946–59.PubMedCrossRefGoogle Scholar
  40. 40.
    Simoni JM, et al. Efficacy of interventions in improving highly active antiretroviral therapy adherence and HIV-1 RNA viral load. A meta-analytic review of randomized controlled trials. JAIDS 2006; 43 Suppl 1: S23-35.PubMedCrossRefGoogle Scholar
  41. 41.
    Crepaz N, et al. Do prevention interventions reduce HIV risk behaviours among people living with HIV? A meta-analytic review of controlled trials. AIDS 2006; 20(2):143–57.PubMedCrossRefGoogle Scholar
  42. 42.
    Johnson BT, et al. Behavioral interventions for African Americans to reduce sexual risk of HIV: A meta-analysis of randomized controlled trials. JAIDS 2009; 51(4):492–501.PubMedCrossRefGoogle Scholar

Copyright information

© The Society of Behavioral Medicine 2011

Authors and Affiliations

  • Seth C. Kalichman
    • 1
    • 4
  • Chauncey Cherry
    • 1
  • Denise White
    • 1
  • Miche’l Jones
    • 1
  • Tamar Grebler
    • 1
  • Moira O. Kalichman
    • 1
  • Mervi Detorio
    • 2
  • Angela M. Caliendo
    • 2
  • Raymond F. Schinazi
    • 3
  1. 1.University of ConnecticutStorrsUSA
  2. 2.Department of Pathology and Laboratory Medicine and Center for AIDS ResearchEmory University School of MedicineAtlantaUSA
  3. 3.Center for AIDS ResearchEmory University School of Medicine and Veterans Affairs Medical CenterAtlantaUSA
  4. 4.Department of PsychologyUniversity of ConnecticutStorrsUSA

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