HAART optimism linked to increased risk taking on large scale in US

Keith Alcorn
Estimated reading time 2 minutes
This article is more than 24 years old.

US researchers have reported that 31% of gay men, injecting drug users and heterosexual men and women questioned during 1998 and 1999 said that they had become less concerned about becoming infected with HIV since the advent of HAART, and 17% said they were taking fewer precautions (condom use or avoidance of needle sharing) since they heard about HAART (Lehman)

The trend was particularly strong amongst injecting drug users, who were significantly more likely to report increased risk taking, However, 65% of gay men who had become less concerned about HIV infection reported unprotected anal intercourse with a casual partner in the previous year, compared with 41% of those whose views about HIV infection remained unchanged.

Sexual risk taking is likely to be encouraged by widespread US publicity for the news that people with viral load below 1500 copies did not transmit HIV in a one year study of 90 Ugandan male-female couples.

Glossary

person years

In a study “100 person years of follow-up” could mean that information was collected on 100 people for one year, or on 50 people for two years each, or on ten people over ten years. In practice, each person’s duration of follow-up is likely to be different.

trend

In everyday language, a general movement upwards or downwards (e.g. every year there are more HIV infections). When discussing statistics, a trend often describes an apparent difference between results that is not statistically significant. 

log

Short for logarithm, a scale of measurement often used when describing viral load. A one log change is a ten-fold change, such as from 100 to 10. A two-log change is a one hundred-fold change, such as from 1,000 to 10.

unprotected anal intercourse (UAI)

In relation to sex, a term previously used to describe sex without condoms. However, we now know that protection from HIV can be achieved by taking PrEP or the HIV-positive partner having an undetectable viral load, without condoms being required. The term has fallen out of favour due to its ambiguity.

detectable viral load

When viral load is detectable, this indicates that HIV is replicating in the body. If the person is taking HIV treatment but their viral load is detectable, the treatment is not working properly. There may still be a risk of HIV transmission to sexual partners.

Speaking on the first day of the Seventh Retroviruses Conference in San Francisco, Dr Thomas Quinn of Johns Hopkins University in Baltimore reported that a clear association exists between viral load level and transmission risk. Each one log increase in viral load was associated with a 2.45-fold increase in transmission risk during the course of a year. Partners of individuals with viral load above 50,000 copies were becoming infected with HIV at a rate of 23 per 100 person years, compared with an average of 12 infections per 100 person years across the whole cohort

Both Dr Quinn and a Zambian research group reported no detectable difference in the risk of transmission from men to women or from women to men, challenging the widely held view that women are at greater risk from HIV than men in African countries (Quinn; Fideli).

Click here for conference abstracts and video/audio feed of conference presentations.

Detailed summaries of each days' proceedings by leading clinicians are available at Medscape HIV/AIDS

References

Fideli U et al. Virologic determinants of heterosexual transmission in Africa. Abstract 194, Seventh Conference on Retroviruses, San Francisco, 2000.

Lehman J et al. Are at-risk populations less concerned about HIV infection in the HAART era? Abstract 198, Seventh Conference on Retroviruses, San Francisco, 2000.

Quinn T et al. Viral load and risk of heterosexual transmission of HIV-1 among sexual partners. Abstract 193, Seventh Conference on Retroviruses, San Francisco, 2000.

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