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  Conference on Retroviruses
and Opportunistic Infections (CROI)
February 22-25, 2016, Boston MA
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Perception of Infectiousness in HIV-infected persons after initiating ART: ACTG A5257.......Few on ART in ACTG Analysis Think They Cannot Transmit HIV
  Conference on Retroviruses and Opportunistic Infections (CROI), February 22-25, 2016, Boston
Mark Mascolini
WEBCAST link: http://www.croiwebcasts.org/console/player/29470?mediaType=audio&
Few adults starting antiretroviral therapy (ART) and taking it for 48 weeks or more thought they could not transmit HIV, a finding that bolsters hope for effective HIV prevention [1]. But half of the study group believed their chance of transmitting HIV dwindled during the first 48 weeks of ART.
Although reaching an undetectable viral load with ART greatly lowers risk of HIV transmission, AIDS Clinical Trials Group (ACTG) investigators who ran this study noted that the impact of ART "is not immediate and transmission protection may be incomplete." They set out to assess changes in perception of infectiousness (POI) in HIV-positive adults starting ART for the first time.
ACTG A5257 enrolled antiretroviral-naive adults and randomized them in an open-label design to atazanavir/ritonavir, darunavir/ritonavir, or raltegravir, all with tenofovir/emtricitabine. Participants had behavioral assessments when they started the study (baseline) then every 48 weeks, including a POI question: How likely would you be to give someone HIV if you had unprotected sex with them TODAY? On a scale of 0 to 100, 0 meant not infectious, 1 to 33 meant a low risk, 34 to 66 a moderate risk, and 67 to 100 a high risk.
Among the 1809 participants, 24% were women, 42% black, 34% white, and 22% Hispanic. Age averaged 37 years, and median pretreatment viral load and CD4 count stood at 4.6 log10 (about 40,000 copies) and 308 cells. At baseline only 6% of participants considered themselves noninfectious. That proportion inched up to 10% at week 48, 12% at week 96, and 14% at week 144. More than half of study participants (58%) considered themselves highly infectious at baseline. That proportion fell to a still considerable 38% at week 48 and did not drop much after that. The proportion who thought they had a low chance of transmitting HIV rose from 10% at baseline to 32% at week 48 and changed little after that. Actual viral suppression had no impact on perception of infectiousness.
Among 1311 people with follow-up data, 49% thought their risk of transmitting HIV fell at week 48, but only 7.6% thought they became noninfectious at week 48.
Multivariate analysis identified three groups who believed they became less infectious over time: those with an initial medium POI (versus a low POI) (adjusted relative risk ratio [aRRR] 4.4) or high POI (aRRR 4.2) and people 18 to 29 years old (versus 30-to-39-year-olds) (aRRR 1.2). Four groups proved less likely to believe their POI fell: blacks (versus whites) (aRRR 0.8), people with an initial CD4 count below 50, people with 12 or fewer years of education, and high-school graduates (versus college graduates) (aRRR 0.7 for all three groups).
Two groups proved more likely to think they became noninfectious with ART: Hispanics (versus whites) (aRRR 2.3) and women (versus men) (aRRR 1.9). Two groups were less likely to think they became noninfectious: people with an initially high POI (versus a low POI) (aRRR 0.4) and people who used any stimulant (aRRR 0.6).
"Understanding how POI changes due to therapy, and how it relates to condomless sex," the researchers suggested, "will be critical for designing interventions to maximize the benefits of treatment as prevention."
1. Landovitz RJ Tran TT, Cohn SE, et al. Perception of infectiousness in HIV-infected persons after initiating ART: ACTG A5257. Conference on Retroviruses and Opportunistic Infections (CROI), February 22-25, 2016, Boston. Abstract 55.
from Jules: look at graph, 14% after 144 weeks considered themselves not infectious, and 35% with low infectiousness.
Perception of Infectiousness in HIV-infected persons after initiating ART: ACTG A5257
Landovitz RJ, Tran TTT, Cohn SE, Ofotokun I, Bishopric G, Godfrey C, Lennox JL, Currier JS, and Ribaudo HJ