Individual and Couple-level Risk Factors Associated with HIV Transmission, Family Planning, and ART Initiation in an Open Cohort of Heterosexual HIV-1 Serodiscordant Couples in Rwanda
Individual and Couple-level Risk Factors Associated with HIV Transmission, Family Planning, and ART Initiation in an Open Cohort of Heterosexual HIV-1 Serodiscordant Couples in Rwanda

Author: Megan Claire Dillavou

Publisher:

Published: 2016

Total Pages: 108

ISBN-13:

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Understanding the factors of heterosexual HIV-1 serodiscordant couples that lead to risky behaviors for HIV transmission are essential in controlling the HIV epidemic in sub-Saharan Africa. Predictors of HIV transmission within stable discordant couples and trends in family planning over time, as well as predictors of ART initiation provide important information for future studies and prevention and treatment program development. This dissertation evaluates these aspects of HIV-1 serodiscordant couple transmission in an ART naive 10-year observational cohort in Kigali, Rwanda. The first study evaluated the incident HIV-1 infections and the predictors of HIV-1 transmission in ART na?ve HIV-1 heterosexual serodiscordant couples. Eighty-three partner linked incident HIV-1 infections occurred in the cohort with 37 in women (IR=2.2/100 CY; 95%CI: 1.53.299) and 46 in men (IR=2.49/100 CY; 95%CI: 1.83-3.33). In the adjusted final model of linked HIV infection in females, baseline VL (aHR 2.33; 95%CI: 1.28-4.24), female genital inflammation (cHR 4.77; 95%CI: 1.72-13.21), and having unprotected sex with study partner since last visit (cHR 3.29; 95%CI: 1.27-8.51) were significant predictors. Predictors of linked incident HIV-1 infection in males included baseline VL (aHR 2.14; 95%CI: 1.50-3.07), female genital inflammation (aHR 3.91; 95%CI: 1.71-8.94), any unprotected sex with study partner since previous visit (aHR 3.56; 95%CI: 1.48-8.56), and presence of sperm on a wet prep (aHR 3.35; 95%CI: 0.99-11.36). These findings support the need to include sexual partners in the assessment of risk and target risk reduction strategies. The second study described pregnancy and analyzed predictors of women ever using hormonal contraception (HC) by HIV status. Overall pregnancy incidence rate was 12.7/100 PY (95%CI: 11.3-14.1) while in M-F+ couples it was 13.2/100 PY (95%CI: 11.3-15.3) and 12.1/100 PY (95%CI: 10.2-14.1) in M+F- couples. 34% of HIV positive women, 26% of HIV- women who did not seroconvert, and 25% of HIV- women who seroconverted had used hormonal contraception at point during the study. In adjusted analyses, being younger (aRR 0.97; 95%CI: 0.95-0.99), ability to read Kinyarwandan easily (aRR 1.28; 95%CI: 1.06-1.55), and no STI in the past year (aRR 0.80; 95%CI: 0.67-0.95) was associated with ever HC use in HIV+ women. Among HIV negative women who did not seroconvert, HC ever use was associated with younger age (aRR 0.98; 95%CI: 0.96-1.0) and not being pregnant at baseline (aRR 0.72; 95%CI: 0.55-0.94). Across HIV groups, injectable methods were the most frequently used type of hormonal contraception at last visit and during most of study follow-up. The overall low uptake of hormonal contraception and high pregnancy rates in both HIV + and HIV- women suggest the need for more effective and widely accessible safer conception methods. The third study evaluated predictors of time to ART initiation, stratified by gender of seropositive partner. Of the 1837 couples (882 M+F- / 955 M-F+), 30% had an HIV positive partner initiate ART. Of those, 39% had a seropositive male partner (M+F-) and 61% had a seropositive female partner (M-F+). Shorter time to ART initiation in M+F- couples was predicted by baseline viral load (aHR1.54; 95%CI:1.01-2.34), while both baseline viral load (aHR1.43; 95%CI:1.02-2.02) and baseline WHO stage IV (aHR 4.85; 95%CI:1.45-16.26) predicted earlier time to ART initiation in M-F+ couples. As expected, clinical values were the main predictors of time to ART initiation. In conclusion, partner and partnership characteristics play an important in risk of HIV-1 acquisition and transmission in heterosexual serodiscordant couples. Family planning and fertility desires are particularly complex and important risk factors that may change over time for serodiscordant couples. These findings can help improve the targeted HIV prevention, safer conception and family planning services, and ART treatment programs focusing on sustained viral load suppression among heterosexual serodiscordant couples in Africa.

Evaluating Individual and Couple-level Risk Factors Associated with HIV Acquisition in HIV Serodiscordant Couples in Zambia: Alcohol Use, Fertility Desire, and HIV Acquisition from Outside Partners in an Open Cohort in Zambia
Evaluating Individual and Couple-level Risk Factors Associated with HIV Acquisition in HIV Serodiscordant Couples in Zambia: Alcohol Use, Fertility Desire, and HIV Acquisition from Outside Partners in an Open Cohort in Zambia

Author: Dvora Leah Davey

Publisher:

Published: 2016

Total Pages: 93

ISBN-13:

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The high prevalence of serodiscordant relationships coupled with the high risk of transmission within those relationships across sub-Saharan African countries makes these couples a target for HIV prevention efforts. The development of appropriate and effective interventions for HIV prevention in serodiscordant couples must be based on accurate assessments of sexual risk behaviors, substance use, and fertility desires. My dissertation evaluates HIV acquisition and transmission in heterosexual HIV serodiscordant couples in Lusaka, Zambia. My first study analyzed the role that alcohol use plays on sexual behavior and HIV acquisition in Zambian serodiscordant couples. Men who reported heavy drinking was associated with increased odds of having =>1 outside sexual partnership (adjusted odds ratio [aOR]=2.02; 95% CI=1.58, 2.57), and condomless sex with main partner in the past 3-months (aOR=1.61; 95% CI=1.28, 2.04). Women's heavy drinking was associated with increased odds of having =>1 outside partner (aOR=1.89, 95% CI=1.35, 2.64), and condomless sex with main partner in past 3-months (aOR=1.54; 95% CI=1.31, 1.82). Women who reported being drunk daily or almost daily was associated with increased HIV acquisition (aHR=3.71; 95% CI=0.90, 15.25). Men who reported being drunk weekly or daily/almost daily was associated with increased HIV acquisition (aHR=1.72; 95% CI= 1.01, 2.93), and transmission (aHR=1.42; 95% CI=0.97, 2.10). My second study evaluated the incidence and predictors of HIV acquisition from an outside partner in serodiscordant couples in Zambia. Forty-five unlinked HIV infections occurred among women (1.85 per 100-couple-years [CY]) and 55 unlinked HIV infections occurred among men (1.82 per 100 CY). Risk of female unlinked infection was associated with baseline female alcohol consumption (aHR=5.44; 95% CI: 1.03, 28.73), recent genital ulcers and/or genital inflammation (aHR=6.09; 95% CI: 2.72, 13.64 and aHR=11.92; 95% CI: 5.60, 25.37, respectively). Risk of male unlinked HIV infection was associated with reporting being drunk weekly or daily/almost daily at baseline (aHR=3.52; 95% CI=1.19, 10.46), recent genital inflammation (aHR=8.52; 95% CI: 3.82, 19.03), genital ulceration (aHR=4.27; 95% CI: 2.05, 8.89), self-reporting =>1 outside partner (aHR=3.36; 95% CI: 1.53, 7.37). My third study evaluated the effect of fertility desires on HIV acquisition among HIV serodiscordant couples in Zambia. Among a sub-set of 1,029 serodiscordant couples, 311 agreed that they wanted a child in the future (30.4%), and 368 agreed they did not want a child or did not know (36.0%), and 344 couples disagreed about having a child (33.6%), of which in 212 couples (61.6% of disagreeing couples) the man wanted a child but the woman did not, and in 132 couples (38.3% of disagreeing couples) the woman wanted a child but the man did not. The adjusted risk ratio for woman's HIV acquisition was 2.06 (95% CI=1.40, 3.03) among women who wanted a child, 1.75 (95% CI=1.07, 2.87) for men who wanted a child in the next 12-months, and 2.55 (95% CI=1.32, 4.93) among couples who agreed that they wanted a child compared to couples who agreed they did not want a child. In conclusion, heavy alcohol use plays an important role in linked and unlinked HIV acquisition and transmission in serodiscordant couples. The strongest predictors of unlinked infection in serodiscordant relationships were alcohol use, genital inflammation and ulceration prior to infection. Further, women were particularly vulnerable when they or their partner wanted to have a child. These findings will help improve the implementation of HIV prevention and safer conception services among heterosexual serodiscordant couples in Southern Africa and beyond.

Disease Control Priorities, Third Edition (Volume 6)
Disease Control Priorities, Third Edition (Volume 6)

Author: King K. Holmes

Publisher: World Bank Publications

Published: 2017-11-06

Total Pages: 1027

ISBN-13: 1464805253

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Infectious diseases are the leading cause of death globally, particularly among children and young adults. The spread of new pathogens and the threat of antimicrobial resistance pose particular challenges in combating these diseases. Major Infectious Diseases identifies feasible, cost-effective packages of interventions and strategies across delivery platforms to prevent and treat HIV/AIDS, other sexually transmitted infections, tuberculosis, malaria, adult febrile illness, viral hepatitis, and neglected tropical diseases. The volume emphasizes the need to effectively address emerging antimicrobial resistance, strengthen health systems, and increase access to care. The attainable goals are to reduce incidence, develop innovative approaches, and optimize existing tools in resource-constrained settings.

Understanding Risk Factors for HIV-1 Infectiousness and Transmission
Understanding Risk Factors for HIV-1 Infectiousness and Transmission

Author: Erin M. Kahle

Publisher:

Published: 2013

Total Pages: 119

ISBN-13:

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The studies described in this dissertation focus on clinical and biologic factors associated with increased HIV-1 infectiousness among heterosexual HIV-1 serodiscordant couples. The specific aims include 1) evaluating whether specific characteristics of HIV-1 serodiscordant couples could be used to defined a higher-risk subgroup for targeted prevention research, 2) assessing the prevalence of unreported antiretroviral therapy (ART) in HIV-1 infected participants enrolling in an HIV-1 prevention trial, 3) determining whether HIV-1 subtype C is associated with increased HIV-1 transmission, and 4) assessing whether immune activation is associated with increased HIV-1 transmission. The identification of a composite set of predictors for HIV-1 transmission is applicable to the design of efficient prevention programs targeting high-risk subpopulations to maximize limited prevention resources. We developed a risk score for identifying a high-risk subpopulation of HIV-1 serodiscordant couples which will provide greater predictive ability in identifying HIV-1 transmission risk than individual risk predictors (i.e. viral load, unprotected sex). A well-developed and validated risk scoring tool, such as ours, is a valuable addition to HIV-1 prevention intervention research in order to reduce sample size, decrease cost of study and provide more efficient recruitment. Biologic factors, including both viral and host characteristics, may be associated with increased HIV-1 infectiousness. HIV-1 subtype, specifically subtype C, has been suggested as a factor in differential HIV-1 transmission between populations, although no epidemiologic evidence supports this conclusion. We compared HIV-1 subtype C and non-C subtypes and found no significant difference in risk of HIV-1 transmission in a multinational population in sub-Saharan Africa. In an analysis of cytokines as markers for immune activation, we found elevated IL-10 and IP-10 concentrations to be associated with increased HIV-1 transmission and acquisition, suggesting a potential biologic mechanism in both HIV-1 infected and susceptible partners. HIV-1 serodiscordant couples cohorts offer unique opportunities to assess correlates of HIV-1 infectiousness, as transmissions can be directly measured within partnerships. The application of our study findings will provide more efficient methods for identifying target populations and a better understanding of the virologic and immunologic mechanisms of HIV-1 infectiousness.

Antiretroviral Treatment as Prevention in African HIV-1 Serodiscordant Couples
Antiretroviral Treatment as Prevention in African HIV-1 Serodiscordant Couples

Author: Andrew Mujugira

Publisher:

Published: 2016

Total Pages: 78

ISBN-13:

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The studies described in this dissertation examine the relationship between use of antiretroviral therapy (ART) and biologic and behavioral factors related to HIV-1 transmission risk in stable heterosexual HIV-1 serodiscordant African couples. ART is recommended for all HIV-1 infected persons, regardless of CD4 count, to reduce HIV-1 related morbidity, mortality and risk of transmission to uninfected partners. ART is a cornerstone of combination HIV-1 prevention, and optimizing use of ART, both for treatment and prevention, is an urgent public health priority. The complementary prospective studies presented in this dissertation were secondary analyses of data from the Partners PrEP Study, a randomized clinical trial of daily oral pre-exposure prophylaxis (PrEP) to decrease HIV-1 acquisition among HIV-1 uninfected members of serodiscordant couples in Kenya and Uganda. This work includes prospective studies of: 1) correlates of failure to achieve plasma viral suppression and virologic rebound after initial suppression, 2) frequency, magnitude and correlates of seminal HIV-1 RNA shedding in men initiating ART, 3) residual HIV-1 transmission risk during the first 6 months of ART, and 4) sexual risk behavior before and after ART. Younger age was associated with delayed ART initiation, failure to achieve viral suppression, and increased risk of virologic rebound after initial suppression. Seminal HIV-1 RNA shedding was infrequent and present at low levels in HIV-1 infected African men with suppressed blood HIV-1 RNA. There were no HIV-1 transmission events on suppressive ART. We observed residual HIV-1 transmission risk during the first 6-months of ART, prior to complete viral suppression in blood and genital secretions. Importantly, substantial risk compensation did not occur following ART initiation among HIV-1 infected persons with known uninfected partners. Results from this dissertation contribute further evidence of the effectiveness of ART for HIV-1 prevention, and provide reassurance that HIV-1 transmission risk declines after starting ART. As treatment guidelines evolve from wait-and-treat to test-and-treat, scaling up access to HIV-1 testing, improving linkage and retention in care, and achieving high ART coverage and complete viral suppression at individual and population levels are essential to achieving zero new HIV-1 infections and zero AIDS-related deaths.

Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection
Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection

Author: World Health Organization

Publisher:

Published: 2016

Total Pages: 429

ISBN-13: 9789241549684

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These guidelines provide guidance on the diagnosis of human immunodeficiency virus (HIV) infection, the use of antiretroviral (ARV) drugs for treating and preventing HIV infection and the care of people living with HIV. They are structured along the continuum of HIV testing, prevention, treatment and care. This edition updates the 2013 consolidated guidelines on the use of antiretroviral drugs following an extensive review of evidence and consultations in mid-2015, shared at the end of 2015, and now published in full in 2016. It is being published in a changing global context for HIV and for health more broadly.

A Guide to the Clinical Care of Women with HIV
A Guide to the Clinical Care of Women with HIV

Author: Jean R. Anderson

Publisher: DIANE Publishing Inc.

Published: 2005

Total Pages: 636

ISBN-13: 9780160726118

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NOTE: NO FURTHER DISCOUNT FOR THIS PRODUCT ITEM -OVERSRTOCK SALE-- Significantly reduced price. Edited by Jean R. Anderson. This guide addresses the health care needs unique to women with HIV. It targets clinicians who provide primary care to women as well as those seeking an understanding of how to take care of women with HIV/AIDS. This guide includes tables, figures, color plates, resources, references, and indices. This 2005 edition includes new chapters on international issues and nutrition. Edge indexed."

The Global HIV Epidemics among Sex Workers
The Global HIV Epidemics among Sex Workers

Author: Deanna Kerrigan

Publisher: World Bank Publications

Published: 2012-12-01

Total Pages: 344

ISBN-13: 0821397753

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A global economic analysis of HIV infection amongst sex workers, finding that evidence based and rights affirming interventions are not implemented to the level that their efficacy warrants, and that doing so at scale would be cost effective and deliver significant returns on investment.

Risk Factors Analysis of Longitudinal Viral Dynamics and Immunological Responses Among HIV-discordant Couples
Risk Factors Analysis of Longitudinal Viral Dynamics and Immunological Responses Among HIV-discordant Couples

Author: Xiaoyue Wang

Publisher:

Published: 2018

Total Pages: 50

ISBN-13:

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In their 2011 paper “Prevention of HIV-1 infection with Early Antiretroviral Therapy” (Cohen, et al, New England Journal of Medicine, 2011), an interim analysis was performed for the HPTN 052 Study to address both personal and public health benefits from early antiretroviral therapy (ART) among HIV-infected patients and their HIV-uninfected partners. It was found that at least 96% of genetically linked infections caused by human immunodeficiency virus type I (HIV-1) in serodiscordant couples were prevented by ART [1]. Furthermore, as described in their 2016 paper “Antiretroviral Therapy for the Prevention of HIV-1 Transmission” ((Cohen, et al, New England Journal of Medicine, 2016), offering the antiretroviral therapy to all patients with HIV-1 infection including 5 years of follow-up proves the durability of ART for the prevention of HIV-1 transmission comparing early and delayed ART. As a result, they conclude that the early initiation of ART results in meaningful decrease in genetically linked HIV-1 infections in sexual partners [2]. In this thesis, we intend to perform risk factors analyses to identify key prognostic factors that are associated with the longitudinal progression of viral dynamics and immunological response, reflected by viral loads and CD4+ counts, respectively, via repeated measurements analysis with Linear Mixed-Effects Models and Generalized Estimating Equations (GEE), for the HIV-infected patients receiving early and delayed ART for the HPTN 052 Study. Such analyses provide more insights into how HIV-1 viral dynamics and patient’s immunological response are progressing over time, when the patients are experiencing or yet to experience HIV disease symptoms with ART [2]. After performing all the analyses, it was found that it is better to use Antiretroviral therapy as early as possible based on multivariate analyses for both immediate arm and delayed arm. In addition, we also found that baseline CD4 count, baseline viral load and region are the key risk factors when predicting how the CD4 count and viral load change over time in either immediate arm or delayed arm.

Antiretroviral Therapy Initiation for Treatment and Prevention in East Africa
Antiretroviral Therapy Initiation for Treatment and Prevention in East Africa

Author: Andrew Mujugira

Publisher:

Published: 2013

Total Pages: 28

ISBN-13:

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In serodiscordant couples, provision of antiretroviral therapy (ART) to the HIV-infected partner significantly decreases risk of sexual HIV transmission of HIV. The World Health Organization has recently issued guidelines recommending ART initiation, regardless of CD4 count, for HIV-infected members of serodiscordant couples to prevent HIV transmission to the uninfected partner. We conducted a prospective cohort study among 1998 HIV-infected individuals with known HIV-uninfected partners who were enrolled in the Partners PrEP Study, an HIV prevention clinical trial in Kenya and Uganda. The primary objective was to assess ART initiation in those who became ART-eligible during study follow-up. The cumulative probabilities of initiating ART at 6, 12, and 24 months after referral were 60.8%, 78.8% and 91.5%, respectively. Approximately 40% of HIV-infected partners had not initiated ART six months after initial referrals. Higher CD4 (p0.001), asymptomatic HIV disease (p=0.04), and alcohol use (p=0.001) were significant predictors of ART initiation. To evaluate whether HIV-infected persons would be interested in earlier ART (CD4 350 cells/ [mu] L) for HIV prevention, as recommended by the WHO, we conducted a cross-sectional study among an additional 571 East African HIV-infected individuals in serodiscordant partnerships. The objective of the study was to determine whether fertility intentions were correlated with a greater likelihood to initiate early ART for prevention. We found that HIV-infected partners with fertility intentions were nearly twice as likely to express interest in early ART for HIV prevention (adjusted odds ratio [AHR] 1.83, p=0.02) than those without fertility intentions. Younger age (p