Treatment as long-term prevention: sustained reduction in HIV sexual transmission risk with use of antiretroviral therapy in rural Uganda
Identifieur interne : 000039 ( PascalFrancis/Corpus ); précédent : 000038; suivant : 000040Treatment as long-term prevention: sustained reduction in HIV sexual transmission risk with use of antiretroviral therapy in rural Uganda
Auteurs : 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 R. BangsbergSource :
- AIDS : (London) [ 0269-9370 ] ; 2014.
Descripteurs français
- Pascal (Inist)
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.
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Format Inist (serveur)
| NO : | PASCAL 14-0113676 INIST |
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| ET : | Treatment as long-term prevention: sustained reduction in HIV sexual transmission risk with use of antiretroviral therapy in rural Uganda |
| AU : | 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 R.) |
| AF : | Massachusetts General Hospital, Center for Global Health/Boston, Massachusetts/Etats-Unis (1 aut., 3 aut., 10 aut., 11 aut.); Mbarara University of Science and Technology/Mbarara/Ouganda (2 aut., 4 aut., 5 aut.); Chester M. Pierce MD Division of Global Psychiatry, Department of Psychiatry, Massachusetts General Hospital/Boston, Massachusetts/Etats-Unis (3 aut.); University of California/San Francisco, California/Etats-Unis (6 aut., 7 aut., 8 aut., 9 aut.); Ragon Institute of Massachusetts General Hospital MIT and Harvard, and Harvard Medical School/Boston, Massachusetts/Etats-Unis (11 aut.) |
| DT : | Publication en série; Courte communication, note brève; Niveau analytique |
| SO : | AIDS : (London); ISSN 0269-9370; Etats-Unis; Da. 2014; Vol. 28; No. 2; Pp. 267-271; Bibl. 20 ref. |
| LA : | Anglais |
| EA : | 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. |
| CC : | 002B05C02D; 002B05A02; 002B02S05 |
| FD : | SIDA; Maladie sexuellement transmissible; Antiviral; Chimiothérapie; Long terme; Prévention; Virus immunodéficience humaine; Comportement sexuel; Antirétroviral; Milieu rural; Ouganda; Afrique subsaharienne |
| FG : | Virose; Infection; Traitement; Lentivirus; Retroviridae; Virus; Afrique; Immunodéficit; Immunopathologie |
| ED : | AIDS; Sexually transmitted disease; Antiviral; Chemotherapy; Long term; Prevention; Human immunodeficiency virus; Sexual behavior; Antiretroviral agent; Rural environment; Uganda; Sub-Saharan Africa |
| EG : | Viral disease; Infection; Treatment; Lentivirus; Retroviridae; Virus; Africa; Immune deficiency; Immunopathology |
| SD : | SIDA; Enfermedad de transmisión sexual; Antiviral; Quimioterapia; Largo plazo; Prevención; Human immunodeficiency virus; Conducta sexual; Antiretroviral; Medio rural; Uganda; Africa subsahariana |
| LO : | INIST-22094.354000501136880140 |
| ID : | 14-0113676 |
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Bangsberg</name><affiliation><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></affiliation><affiliation><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></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">14-0113676</idno><date when="2014">2014</date><idno type="stanalyst">PASCAL 14-0113676 INIST</idno><idno type="RBID">Pascal:14-0113676</idno><idno type="wicri:Area/PascalFrancis/Corpus">000039</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Treatment as long-term prevention: sustained reduction in HIV sexual transmission risk with use of antiretroviral therapy in rural Uganda</title><author><name sortKey="Siedner, Mark J" sort="Siedner, Mark J" uniqKey="Siedner M" first="Mark J." last="Siedner">Mark J. Siedner</name><affiliation><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></affiliation></author><author><name sortKey="Musinguzi, Nicholas" sort="Musinguzi, Nicholas" uniqKey="Musinguzi N" first="Nicholas" last="Musinguzi">Nicholas Musinguzi</name><affiliation><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></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><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></affiliation><affiliation><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></affiliation></author><author><name sortKey="Muzoora, Conrad" sort="Muzoora, Conrad" uniqKey="Muzoora C" first="Conrad" last="Muzoora">Conrad Muzoora</name><affiliation><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></affiliation></author><author><name sortKey="Kembabazi, Annet" sort="Kembabazi, Annet" uniqKey="Kembabazi A" first="Annet" last="Kembabazi">Annet Kembabazi</name><affiliation><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></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><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></affiliation></author><author><name sortKey="Bennett, John" sort="Bennett, John" uniqKey="Bennett J" first="John" last="Bennett">John Bennett</name><affiliation><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></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><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></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><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></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><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></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><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></affiliation><affiliation><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></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></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><inist><standard h6="B"><pA><fA01 i1="01" i2="1"><s0>0269-9370</s0></fA01><fA03 i2="1"><s0>AIDS : (Lond.)</s0></fA03><fA05><s2>28</s2></fA05><fA06><s2>2</s2></fA06><fA08 i1="01" i2="1" l="ENG"><s1>Treatment as long-term prevention: sustained reduction in HIV sexual transmission risk with use of antiretroviral therapy in rural Uganda</s1></fA08><fA11 i1="01" i2="1"><s1>SIEDNER (Mark J.)</s1></fA11><fA11 i1="02" i2="1"><s1>MUSINGUZI (Nicholas)</s1></fA11><fA11 i1="03" i2="1"><s1>TSAI (Alexander C.)</s1></fA11><fA11 i1="04" i2="1"><s1>MUZOORA (Conrad)</s1></fA11><fA11 i1="05" i2="1"><s1>KEMBABAZI (Annet)</s1></fA11><fA11 i1="06" i2="1"><s1>WEISER (Sheri D.)</s1></fA11><fA11 i1="07" i2="1"><s1>BENNETT (John)</s1></fA11><fA11 i1="08" i2="1"><s1>HUNT (Peter W.)</s1></fA11><fA11 i1="09" i2="1"><s1>MARTIN (Jeffrey N.)</s1></fA11><fA11 i1="10" i2="1"><s1>HABERER (Jessica E.)</s1></fA11><fA11 i1="11" i2="1"><s1>BANGSBERG (David R.)</s1></fA11><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></fA14><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></fA14><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></fA14><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></fA14><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></fA14><fA20><s1>267-271</s1></fA20><fA21><s1>2014</s1></fA21><fA23 i1="01"><s0>ENG</s0></fA23><fA43 i1="01"><s1>INIST</s1><s2>22094</s2><s5>354000501136880140</s5></fA43><fA44><s0>0000</s0><s1>© 2014 INIST-CNRS. All rights reserved.</s1></fA44><fA45><s0>20 ref.</s0></fA45><fA47 i1="01" i2="1"><s0>14-0113676</s0></fA47><fA60><s1>P</s1><s3>CC</s3></fA60><fA61><s0>A</s0></fA61><fA64 i1="01" i2="1"><s0>AIDS : (London)</s0></fA64><fA66 i1="01"><s0>USA</s0></fA66><fC01 i1="01" l="ENG"><s0>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.</s0></fC01><fC02 i1="01" i2="X"><s0>002B05C02D</s0></fC02><fC02 i1="02" i2="X"><s0>002B05A02</s0></fC02><fC02 i1="03" i2="X"><s0>002B02S05</s0></fC02><fC03 i1="01" i2="X" l="FRE"><s0>SIDA</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="ENG"><s0>AIDS</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="SPA"><s0>SIDA</s0><s5>01</s5></fC03><fC03 i1="02" i2="X" l="FRE"><s0>Maladie sexuellement transmissible</s0><s5>02</s5></fC03><fC03 i1="02" i2="X" l="ENG"><s0>Sexually transmitted disease</s0><s5>02</s5></fC03><fC03 i1="02" i2="X" l="SPA"><s0>Enfermedad de transmisión sexual</s0><s5>02</s5></fC03><fC03 i1="03" i2="X" l="FRE"><s0>Antiviral</s0><s5>04</s5></fC03><fC03 i1="03" i2="X" l="ENG"><s0>Antiviral</s0><s5>04</s5></fC03><fC03 i1="03" i2="X" l="SPA"><s0>Antiviral</s0><s5>04</s5></fC03><fC03 i1="04" i2="X" l="FRE"><s0>Chimiothérapie</s0><s5>05</s5></fC03><fC03 i1="04" i2="X" l="ENG"><s0>Chemotherapy</s0><s5>05</s5></fC03><fC03 i1="04" i2="X" l="SPA"><s0>Quimioterapia</s0><s5>05</s5></fC03><fC03 i1="05" i2="X" l="FRE"><s0>Long terme</s0><s5>08</s5></fC03><fC03 i1="05" i2="X" l="ENG"><s0>Long term</s0><s5>08</s5></fC03><fC03 i1="05" i2="X" l="SPA"><s0>Largo plazo</s0><s5>08</s5></fC03><fC03 i1="06" i2="X" l="FRE"><s0>Prévention</s0><s5>09</s5></fC03><fC03 i1="06" i2="X" l="ENG"><s0>Prevention</s0><s5>09</s5></fC03><fC03 i1="06" i2="X" l="SPA"><s0>Prevención</s0><s5>09</s5></fC03><fC03 i1="07" i2="X" l="FRE"><s0>Virus immunodéficience humaine</s0><s2>NW</s2><s5>10</s5></fC03><fC03 i1="07" i2="X" l="ENG"><s0>Human immunodeficiency virus</s0><s2>NW</s2><s5>10</s5></fC03><fC03 i1="07" i2="X" l="SPA"><s0>Human immunodeficiency virus</s0><s2>NW</s2><s5>10</s5></fC03><fC03 i1="08" i2="X" l="FRE"><s0>Comportement sexuel</s0><s5>13</s5></fC03><fC03 i1="08" i2="X" l="ENG"><s0>Sexual behavior</s0><s5>13</s5></fC03><fC03 i1="08" i2="X" l="SPA"><s0>Conducta sexual</s0><s5>13</s5></fC03><fC03 i1="09" i2="X" l="FRE"><s0>Antirétroviral</s0><s5>14</s5></fC03><fC03 i1="09" i2="X" l="ENG"><s0>Antiretroviral agent</s0><s5>14</s5></fC03><fC03 i1="09" i2="X" l="SPA"><s0>Antiretroviral</s0><s5>14</s5></fC03><fC03 i1="10" i2="X" l="FRE"><s0>Milieu rural</s0><s5>15</s5></fC03><fC03 i1="10" i2="X" l="ENG"><s0>Rural environment</s0><s5>15</s5></fC03><fC03 i1="10" i2="X" l="SPA"><s0>Medio rural</s0><s5>15</s5></fC03><fC03 i1="11" i2="X" l="FRE"><s0>Ouganda</s0><s2>NG</s2><s5>16</s5></fC03><fC03 i1="11" i2="X" l="ENG"><s0>Uganda</s0><s2>NG</s2><s5>16</s5></fC03><fC03 i1="11" i2="X" l="SPA"><s0>Uganda</s0><s2>NG</s2><s5>16</s5></fC03><fC03 i1="12" i2="X" l="FRE"><s0>Afrique subsaharienne</s0><s2>NG</s2><s5>17</s5></fC03><fC03 i1="12" i2="X" l="ENG"><s0>Sub-Saharan Africa</s0><s2>NG</s2><s5>17</s5></fC03><fC03 i1="12" i2="X" l="SPA"><s0>Africa subsahariana</s0><s2>NG</s2><s5>17</s5></fC03><fC07 i1="01" i2="X" l="FRE"><s0>Virose</s0></fC07><fC07 i1="01" i2="X" l="ENG"><s0>Viral disease</s0></fC07><fC07 i1="01" i2="X" l="SPA"><s0>Virosis</s0></fC07><fC07 i1="02" i2="X" l="FRE"><s0>Infection</s0></fC07><fC07 i1="02" i2="X" l="ENG"><s0>Infection</s0></fC07><fC07 i1="02" i2="X" l="SPA"><s0>Infección</s0></fC07><fC07 i1="03" i2="X" l="FRE"><s0>Traitement</s0></fC07><fC07 i1="03" i2="X" l="ENG"><s0>Treatment</s0></fC07><fC07 i1="03" i2="X" l="SPA"><s0>Tratamiento</s0></fC07><fC07 i1="04" i2="X" l="FRE"><s0>Lentivirus</s0><s2>NW</s2></fC07><fC07 i1="04" i2="X" l="ENG"><s0>Lentivirus</s0><s2>NW</s2></fC07><fC07 i1="04" i2="X" l="SPA"><s0>Lentivirus</s0><s2>NW</s2></fC07><fC07 i1="05" i2="X" l="FRE"><s0>Retroviridae</s0><s2>NW</s2></fC07><fC07 i1="05" i2="X" l="ENG"><s0>Retroviridae</s0><s2>NW</s2></fC07><fC07 i1="05" i2="X" l="SPA"><s0>Retroviridae</s0><s2>NW</s2></fC07><fC07 i1="06" i2="X" l="FRE"><s0>Virus</s0><s2>NW</s2></fC07><fC07 i1="06" i2="X" l="ENG"><s0>Virus</s0><s2>NW</s2></fC07><fC07 i1="06" i2="X" l="SPA"><s0>Virus</s0><s2>NW</s2></fC07><fC07 i1="07" i2="X" l="FRE"><s0>Afrique</s0><s2>NG</s2></fC07><fC07 i1="07" i2="X" l="ENG"><s0>Africa</s0><s2>NG</s2></fC07><fC07 i1="07" i2="X" l="SPA"><s0>Africa</s0><s2>NG</s2></fC07><fC07 i1="08" i2="X" l="FRE"><s0>Immunodéficit</s0><s5>37</s5></fC07><fC07 i1="08" i2="X" l="ENG"><s0>Immune deficiency</s0><s5>37</s5></fC07><fC07 i1="08" i2="X" l="SPA"><s0>Inmunodeficiencia</s0><s5>37</s5></fC07><fC07 i1="09" i2="X" l="FRE"><s0>Immunopathologie</s0><s5>39</s5></fC07><fC07 i1="09" i2="X" l="ENG"><s0>Immunopathology</s0><s5>39</s5></fC07><fC07 i1="09" i2="X" l="SPA"><s0>Inmunopatología</s0><s5>39</s5></fC07><fN21><s1>146</s1></fN21><fN44 i1="01"><s1>OTO</s1></fN44><fN82><s1>OTO</s1></fN82></pA></standard><server><NO>PASCAL 14-0113676 INIST</NO><ET>Treatment as long-term prevention: sustained reduction in HIV sexual transmission risk with use of antiretroviral therapy in rural Uganda</ET><AU>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 R.)</AU><AF>Massachusetts General Hospital, Center for Global Health/Boston, Massachusetts/Etats-Unis (1 aut., 3 aut., 10 aut., 11 aut.); Mbarara University of Science and Technology/Mbarara/Ouganda (2 aut., 4 aut., 5 aut.); Chester M. Pierce MD Division of Global Psychiatry, Department of Psychiatry, Massachusetts General Hospital/Boston, Massachusetts/Etats-Unis (3 aut.); University of California/San Francisco, California/Etats-Unis (6 aut., 7 aut., 8 aut., 9 aut.); Ragon Institute of Massachusetts General Hospital MIT and Harvard, and Harvard Medical School/Boston, Massachusetts/Etats-Unis (11 aut.)</AF><DT>Publication en série; Courte communication, note brève; Niveau analytique</DT><SO>AIDS : (London); ISSN 0269-9370; Etats-Unis; Da. 2014; Vol. 28; No. 2; Pp. 267-271; Bibl. 20 ref.</SO><LA>Anglais</LA><EA>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.</EA><CC>002B05C02D; 002B05A02; 002B02S05</CC><FD>SIDA; Maladie sexuellement transmissible; Antiviral; Chimiothérapie; Long terme; Prévention; Virus immunodéficience humaine; Comportement sexuel; Antirétroviral; Milieu rural; Ouganda; Afrique subsaharienne</FD><FG>Virose; Infection; Traitement; Lentivirus; Retroviridae; Virus; Afrique; Immunodéficit; Immunopathologie</FG><ED>AIDS; Sexually transmitted disease; Antiviral; Chemotherapy; Long term; Prevention; Human immunodeficiency virus; Sexual behavior; Antiretroviral agent; Rural environment; Uganda; Sub-Saharan Africa</ED><EG>Viral disease; Infection; Treatment; Lentivirus; Retroviridae; Virus; Africa; Immune deficiency; Immunopathology</EG><SD>SIDA; Enfermedad de transmisión sexual; Antiviral; Quimioterapia; Largo plazo; Prevención; Human immunodeficiency virus; Conducta sexual; Antiretroviral; Medio rural; Uganda; Africa subsahariana</SD><LO>INIST-22094.354000501136880140</LO><ID>14-0113676</ID></server></inist></record>Pour manipuler ce document sous Unix (Dilib)
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