Abstract

Background

Persons with acute HIV infection (AHI) have heightened transmission risk. We evaluated potential transmission reduction using behavioral and biomedical interventions in a randomized controlled pilot study in Malawi.

Methods

Persons were randomized 1:2:2 to standard counseling (SC), 5-session behavioral intervention (BI), or behavioral intervention plus 12 weeks of antiretrovirals (ARVs; BIA). All were followed for 26–52 weeks and, regardless of arm, referred for treatment according to Malawi-ARV guidelines. Participants were asked to refer partners for testing.

Results

Among 46 persons (9 SC, 18 BI, 19 BIA), the average age was 28; 61% were male. The median viral load (VL) was 5.9 log copies/mL at enrollment. 67% (10/15) of BIA participants were suppressed (<1000 copies/mL) at week 12 vs 25% BI and 50% SC (P = .07). Although the mean number of reported condomless sexual acts in the past week decreased from baseline across all arms (1.5 vs 0.3 acts), 36% experienced incident sexually transmitted infection by 52 weeks (12% SC, 28% BI, 18% BIA). Forty-one percent (19/46) of participants referred partners (44% SC, 44% BI, 37% BIA); 15 of the partners were HIV-infected.

Conclusions

Diagnosis of AHI facilitates behavioral and biomedical risk reduction strategies during a high-transmission period that begins years before people are typically identified and started on ARVs. Sexually transmitted infection incidence in this cohort suggests ongoing risk behaviors, reinforcing the importance of early intervention with ARVs to reduce transmission. Early diagnosis coupled with standard AHI counseling and early ARV referral quickly suppresses viremia, may effectively change behavior, and could have tremendous public health benefit in reducing onward transmission.

Details

Title
Randomized Controlled Pilot Study of Antiretrovirals and a Behavioral Intervention for Persons With Acute HIV Infection: Opportunity for Interrupting Transmission
Author
Miller, William C 1 ; Rutstein, Sarah E 2 ; Phiri, Sam 3 ; Gift Kamanga 4 ; Nsona, Dominic 3 ; Pasquale, Dana K 5 ; Rucinski, Katherine B 5 ; Chen, Jane S 5 ; Golin, Carol E 6 ; Powers, Kimberly A 5 ; Dennis, Ann M 2 ; Hosseinipour, Mina C 2 ; Eron, Joseph J 2 ; Chege, Wairimu 7 ; Hoffman, Irving F 2 ; Pettifor, Audrey E 5 

 Division of Epidemiology, The Ohio State University, Columbus, Ohio; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 
 Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 
 Lighthouse Trust, Lilongwe, Malawi 
 UNC Project, Lilongwe, Malawi 
 Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 
 Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 
 Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 
Publication year
2019
Publication date
Jan 2019
Publisher
Oxford University Press
e-ISSN
23288957
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
3170969060
Copyright
© The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America. This work is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.