Advertisement

AIDS and Behavior

, Volume 20, Issue 4, pp 699–709 | Cite as

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

  • Jessica F. MagidsonEmail author
  • Xin Li
  • Matthew J. Mimiaga
  • Ayana T. Moore
  • Kriengkrai Srithanaviboonchai
  • Ruth Khalili Friedman
  • Mohammad Limbada
  • James P. Hughes
  • Vanessa Cummings
  • Charlotte A. Gaydos
  • Vanessa Elharrar
  • David Celentano
  • Kenneth H. Mayer
  • Steven A. Safren
Original Paper

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.

Keywords

Adherence Treatment as prevention HIV transmission Amplified risk Alcohol use MSM Biomedical prevention 

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.

Palabras clave

Adherencia Tratamiento como prevención Transmisión del VIH Riesgo amplificado Uso de alcohol Hombres que tienen sexo con hombres Prevención biomédica 

Notes

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.

References

  1. 1.
    Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365:493–505.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Rodger A, Bruun T, Cambiano V, et al. HIV transmission risk through condomless sex if HIV + partner on suppressive ART: PARTNER Study. Presented at the 21st Conference on Retroviruses and Opportunistic Infections (CROI). 2014.Google Scholar
  3. 3.
    Mayer KH, Venkatesh KK. Interactions of HIV, other sexually transmitted diseases, and genital tract inflammation facilitating local pathogen transmission and acquisition. Am J Reprod Immunol. 2011;65:308–16.Google Scholar
  4. 4.
    Kalichman SC, Pellowski J, Turner C. Prevalence of sexually transmitted co-infections in people living with HIV/AIDS: systematic review with implications for using HIV treatments for prevention. Sex Transm Infect. 2011;87:183–90.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    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 Médecins Suisses. 2008;89:165–9.Google Scholar
  6. 6.
    Crepaz N, Marks G, Liau A, et al. Prevalence of unprotected anal intercourse among HIV-diagnosed MSM in the United States: a meta-analysis. AIDS. 2009;23:1617–29.CrossRefGoogle Scholar
  7. 7.
    Kalichman SC. HIV transmission risk behaviors of men and women living with HIV/AIDS: prevalence, predictors, and emerging clinical interventions. Clin Psychol Sci Pract. 2000;17:32–47.CrossRefGoogle Scholar
  8. 8.
    Mayer KH, Skeer MR, O’Cleirigh C, Goshe BM, Safren SA. Factors associated with amplified HIV transmission behavior among American men who have sex with men engaged in care: implications for clinical providers. Ann Behav Med. 2014;47:165–71.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Berg CJ, Michelson SE, Safren SA. Behavioral aspects of HIV care: adherence, depression, substance use, and HIV-transmission behaviors. Infect Dis Clin North Am. 2007;21:181–200.Google Scholar
  10. 10.
    Safren S, Mayer K, Ou S, et al. Adherence to early antiretroviral therapy: results from HPTN 052, a Phase III, multinational randomized trial of ART to prevent HIV-1 sexual transmission in serodiscordant couples. In press.Google Scholar
  11. 11.
    Nakimuli-Mpungu E, Bass JK, Alexandre P, et al. Depression, alcohol use and adherence to antiretroviral therapy in sub-Saharan Africa: a systematic review. AIDS Behav. 2012;16:2101–18.CrossRefPubMedGoogle Scholar
  12. 12.
    Safren SA, Biello KB, Smeaton L, et al. Psychosocial predictors of non-adherence and treatment failure in a large scale multi-national trial of antiretroviral therapy for HIV: data from the ACTG A5175/PEARLS trial. PLoS ONE. 2014;9:e104178.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Lu M, Safren SA, Skolnik PR, et al. Optimal recall period and response task for self-reported HIV medication adherence. AIDS Behav. 2008;12:86–94.CrossRefPubMedGoogle Scholar
  14. 14.
    Feldman BJ, Fredericksen RJ, Crane PK, et al. Evaluation of the single-item self-rating adherence scale for use in routine clinical care of people living with HIV. AIDS Behav. 2013;17:307–18.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Radloff LS. The CES-D scale a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401.CrossRefGoogle Scholar
  16. 16.
    Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addict. 1993;88:791–804.CrossRefGoogle Scholar
  17. 17.
    Safren SA, Hendriksen ES, Smeaton L, et al. Quality of life among individuals with HIV starting antiretroviral therapy in diverse resource-limited areas of the world. AIDS Behav. 2012;16:266–77.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Ware JE. SF-36 health survey: manual and interpretation guide. Boston: The Health Institute: New England Medical Center; 1993.Google Scholar
  19. 19.
    Zimet GD, Powell SS, Farley GK, Werkman S, Berkoff KA. Psychometric characteristics of the multidimensional scale of perceived social support. J Pers Assess. 1990;55:610–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Timm N. Multivariate analysis with applications in education and psychology. Monterey: Brooks/Cole; 1975.Google Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Jessica F. Magidson
    • 1
    Email author
  • Xin Li
    • 2
  • Matthew J. Mimiaga
    • 1
    • 3
    • 4
  • Ayana T. Moore
    • 5
  • Kriengkrai Srithanaviboonchai
    • 6
    • 7
  • Ruth Khalili Friedman
    • 8
  • Mohammad Limbada
    • 9
  • James P. Hughes
    • 2
    • 10
  • Vanessa Cummings
    • 11
  • Charlotte A. Gaydos
    • 11
  • Vanessa Elharrar
    • 12
  • David Celentano
    • 13
  • Kenneth H. Mayer
    • 4
    • 14
  • Steven A. Safren
    • 4
    • 15
  1. 1.Department of PsychiatryHarvard Medical School/Massachusetts General HospitalBostonUSA
  2. 2.Fred Hutchinson Cancer Research CenterSeattleUSA
  3. 3.Harvard School of Public HealthBostonUSA
  4. 4.The Fenway Institute, Fenway HealthBostonUSA
  5. 5.FHI360DurhamUSA
  6. 6.Research Institute for Health SciencesChiang Mai UniversityChiang MaiThailand
  7. 7.Faculty of MedicineChiang Mai UniversityChiang MaiThailand
  8. 8.Instituto de Pesquisa Clinica Evandro ChagasRio de JaneiroBrazil
  9. 9.Centre for Infectious Disease Research in ZambiaLusakaZambia
  10. 10.University of WashingtonSeattleUSA
  11. 11.Division of Infectious Diseases, Departments of Pathology and MedicineJohns Hopkins School of MedicineBaltimoreUSA
  12. 12.National Institute of Allergy and Infectious Disease (NIAID)BethesdaUSA
  13. 13.Johns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  14. 14.Harvard Medical School/Beth Israel Deaconess Medical CenterBostonUSA
  15. 15.Department of PsychologyUniversity of MiamiCoral GablesUSA

Personalised recommendations