Adherence to Antiretroviral Therapy and HIV Transmission Risks: Implications for Test-and-Treat Approaches to HIV Prevention

Abstract

HIV transmission may be prevented by effectively suppressing viral replication with antiretroviral therapy (ART). However, adherence is essential to the success of ART, including for reducing HIV transmission risk behaviors. This study examined the association of nonadherence versus adherence with HIV transmission risks. Men (n ¼ 226) living with HIV=AIDS and receiving ART completed confidential computerized interviews and telephone-based unannounced pill counts for ART adherence monitoring. Data were collected between January 2008 and June 2009. Results showed that nonadherence to ART was associated with greater number of sex partners and engaging in unprotected and protected anal intercourse. These associations were not moderated by substance use. The belief that having an undetectable viral load leads to lower infectiousness was associated with greater number of partners, including nonpositive partners, and less condom use. Men who had an undetectable viral load and believed that having an undetectable viral load reduces their infectiousness, were significantly more likely to have contracted a recent STI. Programs aimed at testing and treating people living with HIV=AIDS for prevention require attention to adherence and sexual behaviors.

Non-condom related strategies to reduce the risk of HIV transmission: Perspectives and experiences of gay men with diagnosed HIV

“…A study of HIV positive men in receipt of anti-retroviral therapy (Kalichman et al, 2010) reported an association between the belief that an undetectable viral load reduces the chance of HIV transmission and both a greater number of (sero-discordant) sexual partners and condomless sex. What the current study contributes is a greater understanding of the subtle nuances of how risk reduction is managed, how it is highly contextual, how the stories told about sexual practice depends on when and with whom men are speaking, and how perceptions of risk reduction are influenced by perceived social norms and shared notions of morality.…”

Antiretroviral Treatment Interruption and Loss to Follow-Up in Two HIV Cohorts in Australia and Asia: Implications for ‘Test and Treat’ Prevention Strategy

“…Non-adherence has been associated with greater number of sex partners and engaging in unprotected anal intercourse in some but not all studies. 35,36 In addition to the increasing viral load, just under 50% patient had a CD4 count < 200 cells/lL during the TI, placing these patients at increased risk of AIDS-defining illness. The drop in CD4 count and rebound in viral load seen here are consistent with other studies.…”

HIV testing and counselling in Colombia: evidence from a national health survey and recommendations for health-care services

“…This also includes the need to encourage people to have this carried out, considering that models of HIV prevention based on taking the test could increase timely diagnoses and treatment, with beneficial effects in the medium and long term. 38 Other specific recommendations include:…”