Treatment as long-term prevention

Sustained reduction in HIV sexual transmission risk with use of antiretroviral therapy in rural Uganda

Mark J. Siedner, Nicholas Musinguzi, Alexander C. Tsai, Conrad Muzoora, Annet Kembabazi, Sheri D. Weiser, John Bennett, Peter W. Hunt, Jeffrey N. Martin, Jessica E. Haberer, David Bangsberg

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objectives: Suppressive antiretroviral therapy (ART) substantially decreases HIV transmission in clinical research settings. We sought to measure the frequency and correlates of periods of transmission risk among individuals taking ART during multiple years of observation in rural, southwestern Uganda. Design: Observational cohort study. Methods: We collected sexual behavior and viral load data in a Ugandan cohort of people living with HIV/AIDS from the time of ART initiation. We defined each 90-day visit as a potential transmission period if HIV-1 RNA was more than 400 copies/ml and the participant reported sexual transmission risk behavior, defined as unprotected sexual contact with at least 1 HIV-uninfected partners or partners of unknown serostatus in the prior 90 days. Results: We evaluated data from 463 individuals on ART over a median 3.5 years of observation and 5293 total study visits. During that time, over half (259, 56%) had detectable viremia or reported sexual transmission risk behavior at least once. However, only 23 (5%) had both simultaneously, at 28 (1%) of all visits. Transmission sexual behavior was reported at 6% of visits with detectable viremia. In multivariable regression modeling, correlates of transmission risk periods included younger age, lower CD4\+ cell count, low household asset ownership and increased internalized stigma. Conclusion: Although detectable viremia and/or sexual transmission risk behavior occurred in over half of individuals, ART reduced periods of HIV transmission risk by over 90% during up to 6 years of observation time. These findings provide further support for provision of ART, along with interventions to promote long-term adherence, to reduce HIV transmission in HIV-endemic settings.

Original languageEnglish (US)
Pages (from-to)267-271
Number of pages5
JournalAIDS
Volume28
Issue number2
DOIs
StatePublished - Jan 14 2014
Externally publishedYes

Fingerprint

Uganda
HIV
Viremia
Risk-Taking
Observation
Sexual Behavior
HIV-1
Therapeutics
Ownership
CD4 Lymphocyte Count
Viral Load
Observational Studies
Acquired Immunodeficiency Syndrome
Cohort Studies
RNA
Research

Keywords

  • Antiretroviral therapy
  • HIV/AIDS
  • Sub-Saharan Africa
  • Treatment as prevention
  • Uganda

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Cite this

Treatment as long-term prevention : Sustained reduction in HIV sexual transmission risk with use of antiretroviral therapy in rural Uganda. / Siedner, Mark J.; Musinguzi, Nicholas; Tsai, Alexander C.; Muzoora, Conrad; Kembabazi, Annet; Weiser, Sheri D.; Bennett, John; Hunt, Peter W.; Martin, Jeffrey N.; Haberer, Jessica E.; Bangsberg, David.

In: AIDS, Vol. 28, No. 2, 14.01.2014, p. 267-271.

Research output: Contribution to journalArticle

Siedner, MJ, Musinguzi, N, Tsai, AC, Muzoora, C, Kembabazi, A, Weiser, SD, Bennett, J, Hunt, PW, Martin, JN, Haberer, JE & Bangsberg, D 2014, 'Treatment as long-term prevention: Sustained reduction in HIV sexual transmission risk with use of antiretroviral therapy in rural Uganda', AIDS, vol. 28, no. 2, pp. 267-271. https://doi.org/10.1097/QAD.0000000000000136
Siedner, Mark J. ; Musinguzi, Nicholas ; Tsai, Alexander C. ; Muzoora, Conrad ; Kembabazi, Annet ; Weiser, Sheri D. ; Bennett, John ; Hunt, Peter W. ; Martin, Jeffrey N. ; Haberer, Jessica E. ; Bangsberg, David. / Treatment as long-term prevention : Sustained reduction in HIV sexual transmission risk with use of antiretroviral therapy in rural Uganda. In: AIDS. 2014 ; Vol. 28, No. 2. pp. 267-271.
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abstract = "Objectives: Suppressive antiretroviral therapy (ART) substantially decreases HIV transmission in clinical research settings. We sought to measure the frequency and correlates of periods of transmission risk among individuals taking ART during multiple years of observation in rural, southwestern Uganda. Design: Observational cohort study. Methods: We collected sexual behavior and viral load data in a Ugandan cohort of people living with HIV/AIDS from the time of ART initiation. We defined each 90-day visit as a potential transmission period if HIV-1 RNA was more than 400 copies/ml and the participant reported sexual transmission risk behavior, defined as unprotected sexual contact with at least 1 HIV-uninfected partners or partners of unknown serostatus in the prior 90 days. Results: We evaluated data from 463 individuals on ART over a median 3.5 years of observation and 5293 total study visits. During that time, over half (259, 56{\%}) had detectable viremia or reported sexual transmission risk behavior at least once. However, only 23 (5{\%}) had both simultaneously, at 28 (1{\%}) of all visits. Transmission sexual behavior was reported at 6{\%} of visits with detectable viremia. In multivariable regression modeling, correlates of transmission risk periods included younger age, lower CD4\+ cell count, low household asset ownership and increased internalized stigma. Conclusion: Although detectable viremia and/or sexual transmission risk behavior occurred in over half of individuals, ART reduced periods of HIV transmission risk by over 90{\%} during up to 6 years of observation time. These findings provide further support for provision of ART, along with interventions to promote long-term adherence, to reduce HIV transmission in HIV-endemic settings.",
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AU - Weiser, Sheri D.

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