Modeling HIV Transmission from Sexually Active Alcohol-Consuming Men in ART Programs to Seronegative Wives

Abstract

Background: The rollout of antiviral therapy in Low and Middle Income Countries (LMICs) has reduced HIV transmission rates at the potential risk of resistant HIV transmission. We sought to predict the risk of wild type and antiviral resistance transmissions in these settings. Methods: A predictive model utilizing viral load, ART adherence, genital ulcer disease, condom use, and sexual event histories was developed to predict risks of HIV transmission to wives of 233 HIV+ men in 4 antiretroviral treatment centers in Maharashtra, India. Results: ARV Therapy predicted a 5.71-fold reduction in transmissions compared to a model of using condoms alone, with 79.9%, of remaining transmissions resulting in primary ART-resistance. Conclusions: ART programs reduce transmission of HIV to susceptible partners at a substantial increased risk for transmission of resistant virus. Enhanced vigilance in monitoring adherence, use of barrier protections, and viral load may reduce risks of resistant HIV transmissions in LMIC settings.

Risk of Sexual Transmission of HIV with Antiretroviral Therapy and Variable or Suppressed Viral Load

“…18 The 14 primary studies were published between 2018 and 2022, all of which employed nonrandomized study designs. 13,14,[19][20][21][22][23][24][25][26][27][28][29][30] Seven of the nonrandomized studies used a prospective cohort design 13,14,19,[21][22][23]25 and 7 used a retrospective method. 20,24,[26][27][28][29][30]…”

“…Of these potentially relevant articles, 72 publications were excluded for various reasons, while 15 studies met the inclusion criteria and were included in this report. 13,14,[18][19][20][21][22][23][24][25][26][27][28][29][30] These comprised 1 overview of SRs and/or MAs, 18 and 14 nonrandomized studies. 13,14,[19][20][21][22][23][24][25][26][27][28][29][30] Appendix 1 presents the PRISMA 31 flow chart of the study selection.…”

“…13,14,[18][19][20][21][22][23][24][25][26][27][28][29][30] These comprised 1 overview of SRs and/or MAs, 18 and 14 nonrandomized studies. 13,14,[19][20][21][22][23][24][25][26][27][28][29][30] Appendix 1 presents the PRISMA 31 flow chart of the study selection.…”

“…32 Results of the 2 relevant SRs included in the overview are summarized in the current report. Of the 14 primary studies, 13,14,[19][20][21][22][23][24][25][26][27][28][29][30] only data describing characteristics and findings relevant to the current report were abstracted and summarized herein.…”

“…The lead author of the included overview of the reviews was from Iran. 18 Countries represented by the eligible primary studies included Brazil, 13,27 China, 19,24,26,[28][29][30] Ethiopia, 20 India, 22,23 Kenya, 25 Rwanda, 21 and 2 international studies, 1 of which was conducted in 14 European countries, 14 and the other which including participants from Australia, Brazil, and Thailand. 13…”