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HIV Transmission Risk Behavior in a Cohort of HIV-Infected Treatment-Naïve Men and Women in the United States

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Abstract

Antiretroviral therapy (ART) can minimize HIV transmission. Prevention benefits may be compromised by barriers to virologic suppression, and by increased condomless sex among those initiating ART. We evaluated condomless sex in a cohort of HIVinfected US individuals poised to initiate ART in a clinical trial. We assessed partner and sex act type, condom use, and perception of infectiousness. Six percent of participants reported as not infectious; men who have sex with men were more likely to perceive high infectivity. Prevalence of condomless sex was 44 %; 74 % of those also reported homosexual acquisition of HIV. Predictors of increased risk of condomless sex included greater numbers of lifetime partners, recent stimulant drug use and an HIV-positive or unknown serostatus partner. In the context of serodifferent partners, lower perception of infectiousness was also associated with a higher risk of condomless sex. Results highlight opportunities for prevention education for HIV infected individuals at ART initiation.

Resumen

La terapia antirretroviral (ART) puede reducir la transmisin del VIH. Los beneficios de la prevención puede verse comprometida por barreras a la supresión virológica, y por la creciente tendencia de no usar condones entre aquellos que inician el ART. Hemos evaluado un cohorte de individuos infectados por el VIH que tiene sexo sin condon que estan iniciando ART en un ensayo clínico. Evaluamos su parejas y tipo de acto sexual, el uso de preservativos, y la percepción de la capacidad infecciosa. Seis por ciento de los participantes informó que no es contagioso; hombres que tienen sexo con hombres eran más propensos a percibir alta infectividad. Prevalencia de sexo sin condones fue de 44 %; el 74 % informa que la adquisición del VIH fue por homosexual. Predictores del aumento de sexo sin condon incluyó un mayor número de parejas en sus vidas, uso reciente de drogas estimulantes y un compañero VIH positivo o de seroestado desconocido. En el contexto de parejas serodiferentes su percepcion de infectividad también fue asociado con un mayor riesgo de sexo sin condon. Los resultados pusieron de manifiesto las oportunidades de educación para la prevención para las personas infectadas por el VIH al iniciar ART.

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Acknowledgments

The project described was supported by Award Number U01AI068636 from the National Institute of Allergy and Infectious Diseases and supported by National Institute of Mental Health (NIMH), National Institute of Dental and Craniofacial Research (NIDCR). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Allergy and Infectious Diseases or the National Institutes of Health. The study team would like to additionally thank the ACTG CRS’s that conducted the A5257 protocol and the A5257 study participants. The protocol received support from the AIDS Clinical Trials Group, the Site Data Management Center Grant of UM1AI68634, the ACTG specialty laboratories listed in the manuscript, and the clinical research sites. From the sites we acknowledge the following personnel and AIDS Clinical Trials Unit Grants: Michelle Saemann, RN and Jennifer Baer, RN- Cincinnati CRS (Site 2401) Grant AI069439; Dr. Susan Koletar, Mark Hite RN- Ohio State University CRS (Site 2301) Grant UM1AI069494; Linda Meixner, RN and Edward Seefried, RN- UCSD Antiviral Research Center CRS (Site 701) Grant AI69432; Vicki Bailey, RN and Rebecca Basham, CCRP- Vanderbilt Therapeutics CRS (Site 3652) Grant 2UM1AI069439-08, CTSA Grant UL1 TR000445; David Currin RN and Miriam Chicurel-Bayard RN- Chapel Hill CRS (Site 3201) Grant UM1 AI069423-08, CTSA Grant 1UL1TR001111, CFAR Grant P30 AI50410; Teresa Spitz and Judy Frain- Washington University Therapeutics CRS (Site 2101) Grant UM1AI069439; Elizabeth Lindsey, RN and Tamara James - Alabama Therapeutics CRS (Site 5801) Grant 2UM1AI069452-08; Beverly Putnam and Cathi Basler- University of Colorado Hospital CRS (Site 6101) Grant 2UM1AI069432, CTSA Grant UL1 TR001082; Michael P. Dube, MD and Bartolo Santos, RN- University of Southern California CRS (Site 1201) Grant AI069432; Eric Daar and Sadia Shaik - Harbor UCLA CRS (Site 603) Grant AI069424, CTSA Grant UL1TR000124; Pablo Tebas MD and Aleshia Thomas RN, BSN- Penn Therapeutics CRS (Site 6201) Grant UM1-AI069534-08, CFAR Grant 5-P30-AI-045008-15; Roger Bedimo, MD and Michelle Mba, MPH- Trinity Health and Wellness Center (Site 31443) Grant U01 AI069471; David Cohn MD and Fran Moran RN- Denver Public Health CRS (Site 31470) Grant UM1 AI069503; Jorge L. Santana Bagur, MD and Ileana Boneta Dueño, RN- Puerto Rico AIDS Clinical Trials Unit CRS (Site 5401) Grant 2UM1AI069415-09; Babafemi Taiwo, MBBS, Baiba Berzins, MPH- Northwestern University CRS (Site 2701) Grant 5U01 AI069471; Dr. Emery Chang and Maria Palmer- UCLA CARE Center CRS (Site 601) Grant A1069424; Mary Adams, RN and Christine Hurley, RN - Univ. of Rochester ACTG CRS/AIDS CARE CRS/Trillium Health (Site 1101/Site 1108) Grant 2UM1 AI069511-08, CTSA Grant UL1 TR024160; Timothy Lane and Cornelius Van Dam- Greensboro CRS (Site 3203) Grant A1069423-08; Karen Tashima MD and Helen Patterson LPN - The Miriam Hospital (TMH) CRS (Site 2951) Grant 2UM1A1069412-08; Carlos del Rio, MD & Ericka Patrick, RN- The Ponce de Leon Ctr. CRS (Site 5802) Grant 2UM1 AI069418-08, CFAR Grant P30 AI050409, CTSA Grant UL1 TR000454; Norman Markowitz and Indira Brar- Henry Ford Hosp. CRS (Site 31472) Grant UM 1 A1069503; Roberto C. Arduino, MD, and Maria Laura Martinez- Houston AIDS Research Team CRS (Site 31473) Grant 2 UM1 AI069503-08, 2 UM1 AI068636-08; Rose Kim, MD and Yolanda Smith, BA- Cooper Univ. Hosp. CRS (Site 31476) Grant UM1 AI069503; Hector Bolivar, MD, Margaret A. Fischl, MD - Univ. of Miami AIDS Clinical Research Unit (ACRU) CRS (Site 901) Grant AI069477; Edward Telzak, MD and Richard Cindrich, MD- Bronx-Lebanon Hosp. Ctr. CRS (Site 31469) Grant UM1 AI069503; Paul Sax MD and Cheryl Keenan RN BC- Brigham and Women’s Hospital Therapeutics CRS (Site 107) Grant UM1AI069472; CFAR Grant P30 AI060354, CTSA UL1 TR000170; Kim Whitely, RN and Traci Davis, RN- MetroHealth CRS (Site 2503) Grant AI 69501; CTSA Grant UL1TR000439; Dr. Rodger D. MacArthur and Marti Farrough, RN, BSN - Wayne State Univ. CRS (Site 31478) Grant 2UM1AI069503-08; Judith A. Aberg, MD and Michelle S Cespedes, MPH, MD - NY Univ. HIV/AIDS CRS (Site 401) Grant UM1 AI069532; Shelia Dunaway, MD and Sheryl Storey, PA-C- University of Washington AIDS CRS (Site 1401) Grant UM AI069481; Joel Gallant, MD, and Ilene Wiggins, RN - Johns Hopkins University CRS (Site 201) Grant 2UM1 AI069465, CTSA Grant UL1TR001079; Beverly Sha, MD and Veronica Navarro, RN - Rush University CRS (Site 2702) Grant AI-069471; Vicky Watson RN and Daniel Nixon DO, PhD - Virginia Commonwealth Univ. Medical Ctr. CRS (Site 31475) CPCRA CTU award UM1 AI069503, CTSA UL1TR000058; Annie Luetkemeyer, MD and Jay Dwyer, RN- UCSF HIV/AIDS CRS (Site 801) Grant UM1 AI069496, UCSF-CTSA Grant UL1 TR000004; Kristen Allen RN and Patricia Walton RN- Case CRS (Site 2501) Grant AI069501; Dr. Princy Kumar and Dr. Joseph Timpone- Georgetown University CRS (Site 1008) Grant 1U01AI069494; Mehri McKellar, MD and Jacquelin Granholm, RN- Duke Univ. Med. Ctr. Adult CRS (Site 1601) Grant 5UM1 AI069484-07; Michael T Yin, MD MS and Madeline Torres, RN- Columbia Physicians and Surgeons CRS (Site 30329) Grant 2UM1-AI069470-08, CTSA 5UL1 RR024156; Sandra Valle, PA-C and Debbie Slamowitz, RN- Stanford CRS (Site 501) Grant AI069556; Charles E. Davis Jr., M.D. and William A. Blattner, M.D. - IHV Baltimore Treatment CRS (Site 4651) Grant U01AI069447; BMC ACTG CRS (Site 104) Benjamin Linus, MD, UM1 AI069472; Beth Israel Deaconess Med. Ctr., ACTG CRS (Site 103) Mary Albrecht, MD, UM1 AI069472; CFAR Grant P30 AI060354; Christina Megill, PA-C and Valery Hughes, NP- Cornell Chelsea CRS (Site 7804) Grant UM1AI069419, CTSA Grant UL1TR000457; Teri Flynn, MSN, ANP and Amy Sbrolla BSN, RN - Massachusetts General Hospital CRS (Site 101) Grant 2UM1AI069412-08; CFAR Grant P30 AI060354; Sharon Riddler, MD and Lisa Klevens, BSN- University of Pittsburgh CRS (Site 1001) Grant UM1 AI069494.

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Authors and Affiliations

  1. Division of Infectious Diseases, UCLA Center for Clinical AIDS Research and Education, University of California, Los Angeles, 11075 Santa Monica Blvd, Suite 100, Los Angeles, CA, 90025, USA

    Raphael J. Landovitz & Judith S. Currier

  2. Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, MA, USA

    Thuy Tien T. Tran & Heather J. Ribaudo

  3. Division of Infectious Diseases, Northwestern University School of Medicine, Chicago, IL, USA

    Susan E. Cohn

  4. Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA

    Ighovwhera Ofotokun & Jeffrey L. Lennox

  5. Therapeutics Research Branch, Division of AIDS, National Institutes of Health, Bethesda, MD, USA

    Catherine Godfrey

  6. Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, MA, USA

    Daniel R. Kuritzkes

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  1. Raphael J. Landovitz
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  2. Thuy Tien T. Tran
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  3. Susan E. Cohn
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  4. Ighovwhera Ofotokun
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  5. Catherine Godfrey
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  6. Daniel R. Kuritzkes
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  7. Jeffrey L. Lennox
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  8. Judith S. Currier
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  9. Heather J. Ribaudo
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Correspondence to Raphael J. Landovitz.

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Landovitz, R.J., Tran, T.T.T., Cohn, S.E. et al. HIV Transmission Risk Behavior in a Cohort of HIV-Infected Treatment-Naïve Men and Women in the United States. AIDS Behav 20, 2983–2995 (2016). https://doi.org/10.1007/s10461-016-1365-2

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