Treatment as long-term prevention: sustained reduction in HIV sexual transmission risk with use of antiretroviral therapy in rural Uganda
Identifieur interne : 002060 ( Main/Exploration ); précédent : 002059; suivant : 002061Treatment as long-term prevention: sustained reduction in HIV sexual transmission risk with use of antiretroviral therapy in rural Uganda
Auteurs : Mark J. Siedner [États-Unis] ; Nicholas Musinguzi [Ouganda] ; Alexander C. Tsai [États-Unis] ; Conrad Muzoora [Ouganda] ; Annet Kembabazi [Ouganda] ; Sheri D. Weiser [États-Unis] ; John Bennett [États-Unis] ; Peter W. Hunt [États-Unis] ; Jeffrey N. Martin [États-Unis] ; Jessica E. Haberer [États-Unis] ; David R. Bangsberg [États-Unis]Source :
- AIDS : (London) [ 0269-9370 ] ; 2014.
Descripteurs français
- Pascal (Inist)
- Wicri :
- geographic : Ouganda.
- topic : Maladie sexuellement transmissible.
English descriptors
- KwdEn :
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, IowerCD4+ 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.
Affiliations:
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Siedner</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Massachusetts General Hospital, Center for Global Health</s1><s2>Boston, Massachusetts</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Musinguzi, Nicholas" sort="Musinguzi, Nicholas" uniqKey="Musinguzi N" first="Nicholas" last="Musinguzi">Nicholas Musinguzi</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Mbarara University of Science and Technology</s1><s2>Mbarara</s2><s3>UGA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Ouganda</country><wicri:noRegion>Mbarara University of Science and Technology</wicri:noRegion></affiliation></author><author><name sortKey="Tsai, Alexander C" sort="Tsai, Alexander C" uniqKey="Tsai A" first="Alexander C." last="Tsai">Alexander C. Tsai</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Massachusetts General Hospital, Center for Global Health</s1><s2>Boston, Massachusetts</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Massachusetts</region></placeName></affiliation><affiliation wicri:level="2"><inist:fA14 i1="03"><s1>Chester M. Pierce MD Division of Global Psychiatry, Department of Psychiatry, Massachusetts General Hospital</s1><s2>Boston, Massachusetts</s2><s3>USA</s3><sZ>3 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Muzoora, Conrad" sort="Muzoora, Conrad" uniqKey="Muzoora C" first="Conrad" last="Muzoora">Conrad Muzoora</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Mbarara University of Science and Technology</s1><s2>Mbarara</s2><s3>UGA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Ouganda</country><wicri:noRegion>Mbarara University of Science and Technology</wicri:noRegion></affiliation></author><author><name sortKey="Kembabazi, Annet" sort="Kembabazi, Annet" uniqKey="Kembabazi A" first="Annet" last="Kembabazi">Annet Kembabazi</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Mbarara University of Science and Technology</s1><s2>Mbarara</s2><s3>UGA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Ouganda</country><wicri:noRegion>Mbarara University of Science and Technology</wicri:noRegion></affiliation></author><author><name sortKey="Weiser, Sheri D" sort="Weiser, Sheri D" uniqKey="Weiser S" first="Sheri D." last="Weiser">Sheri D. Weiser</name><affiliation wicri:level="2"><inist:fA14 i1="04"><s1>University of California</s1><s2>San Francisco, California</s2><s3>USA</s3><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Bennett, John" sort="Bennett, John" uniqKey="Bennett J" first="John" last="Bennett">John Bennett</name><affiliation wicri:level="2"><inist:fA14 i1="04"><s1>University of California</s1><s2>San Francisco, California</s2><s3>USA</s3><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Hunt, Peter W" sort="Hunt, Peter W" uniqKey="Hunt P" first="Peter W." last="Hunt">Peter W. Hunt</name><affiliation wicri:level="2"><inist:fA14 i1="04"><s1>University of California</s1><s2>San Francisco, California</s2><s3>USA</s3><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Martin, Jeffrey N" sort="Martin, Jeffrey N" uniqKey="Martin J" first="Jeffrey N." last="Martin">Jeffrey N. Martin</name><affiliation wicri:level="2"><inist:fA14 i1="04"><s1>University of California</s1><s2>San Francisco, California</s2><s3>USA</s3><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Haberer, Jessica E" sort="Haberer, Jessica E" uniqKey="Haberer J" first="Jessica E." last="Haberer">Jessica E. Haberer</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Massachusetts General Hospital, Center for Global Health</s1><s2>Boston, Massachusetts</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Bangsberg, David R" sort="Bangsberg, David R" uniqKey="Bangsberg D" first="David R." last="Bangsberg">David R. Bangsberg</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Massachusetts General Hospital, Center for Global Health</s1><s2>Boston, Massachusetts</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Massachusetts</region></placeName></affiliation><affiliation wicri:level="2"><inist:fA14 i1="05"><s1>Ragon Institute of Massachusetts General Hospital MIT and Harvard, and Harvard Medical School</s1><s2>Boston, Massachusetts</s2><s3>USA</s3><sZ>11 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Massachusetts</region></placeName></affiliation></author></analytic><series><title level="j" type="main">AIDS : (London)</title><title level="j" type="abbreviated">AIDS : (Lond.)</title><idno type="ISSN">0269-9370</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">AIDS : (London)</title><title level="j" type="abbreviated">AIDS : (Lond.)</title><idno type="ISSN">0269-9370</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>AIDS</term><term>Antiretroviral agent</term><term>Antiviral</term><term>Chemotherapy</term><term>Human immunodeficiency virus</term><term>Long term</term><term>Prevention</term><term>Rural environment</term><term>Sexual behavior</term><term>Sexually transmitted disease</term><term>Sub-Saharan Africa</term><term>Uganda</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>SIDA</term><term>Maladie sexuellement transmissible</term><term>Antiviral</term><term>Chimiothérapie</term><term>Long terme</term><term>Prévention</term><term>Virus immunodéficience humaine</term><term>Comportement sexuel</term><term>Antirétroviral</term><term>Milieu rural</term><term>Ouganda</term><term>Afrique subsaharienne</term></keywords><keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>Ouganda</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Maladie sexuellement transmissible</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">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, IowerCD4<sup>+</sup> 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.</div></front></TEI><affiliations><list><country><li>Ouganda</li><li>États-Unis</li></country><region><li>Californie</li><li>Massachusetts</li></region></list><tree><country name="États-Unis"><region name="Massachusetts"><name sortKey="Siedner, Mark J" sort="Siedner, Mark J" uniqKey="Siedner M" first="Mark J." last="Siedner">Mark J. Siedner</name></region><name sortKey="Bangsberg, David R" sort="Bangsberg, David R" uniqKey="Bangsberg D" first="David R." last="Bangsberg">David R. Bangsberg</name><name sortKey="Bangsberg, David R" sort="Bangsberg, David R" uniqKey="Bangsberg D" first="David R." last="Bangsberg">David R. Bangsberg</name><name sortKey="Bennett, John" sort="Bennett, John" uniqKey="Bennett J" first="John" last="Bennett">John Bennett</name><name sortKey="Haberer, Jessica E" sort="Haberer, Jessica E" uniqKey="Haberer J" first="Jessica E." last="Haberer">Jessica E. Haberer</name><name sortKey="Hunt, Peter W" sort="Hunt, Peter W" uniqKey="Hunt P" first="Peter W." last="Hunt">Peter W. Hunt</name><name sortKey="Martin, Jeffrey N" sort="Martin, Jeffrey N" uniqKey="Martin J" first="Jeffrey N." last="Martin">Jeffrey N. Martin</name><name sortKey="Tsai, Alexander C" sort="Tsai, Alexander C" uniqKey="Tsai A" first="Alexander C." last="Tsai">Alexander C. Tsai</name><name sortKey="Tsai, Alexander C" sort="Tsai, Alexander C" uniqKey="Tsai A" first="Alexander C." last="Tsai">Alexander C. Tsai</name><name sortKey="Weiser, Sheri D" sort="Weiser, Sheri D" uniqKey="Weiser S" first="Sheri D." last="Weiser">Sheri D. Weiser</name></country><country name="Ouganda"><noRegion><name sortKey="Musinguzi, Nicholas" sort="Musinguzi, Nicholas" uniqKey="Musinguzi N" first="Nicholas" last="Musinguzi">Nicholas Musinguzi</name></noRegion><name sortKey="Kembabazi, Annet" sort="Kembabazi, Annet" uniqKey="Kembabazi A" first="Annet" last="Kembabazi">Annet Kembabazi</name><name sortKey="Muzoora, Conrad" sort="Muzoora, Conrad" uniqKey="Muzoora C" first="Conrad" last="Muzoora">Conrad Muzoora</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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