Acute HIV infection detection and control reduces
HIV infectiousness and transmission risk behavior
among men who have sex...
Background
 Antiretroviral treatment (ART) reduces HIV viral load and HIV
transmission in HIV discordant heterosexual cou...
RV254/SEARCH010 Study
A cohort of individuals in acute HIV infection (AHI) in Bangkok, Thailand
Purpose:
Describe clinical...
Screening EIA/NAT
69,911 samples
136 AHI identified
April 2009-March 2013
90 MSM in AHI identified
90% undetectable integr...
Baseline Characteristics (n=88) Values
Mean (SD) age 28.5 (7.0) years
Mean (SD) duration of infection 16.5 (6.6) days
4th ...
Baseline Behavioral Characteristics (n=86) Values
Mean (SD) age at first sexual intercourse (years) 18.5 (2.5)
Sexual Part...
Blood plasma viral load
Beyond week 2:
If blood plasma VL < detection, also seminal plasma VL < detection
Seminal plasma viral load
Anal lavage viral load
Sexual Partners
in last 4 months
Baseline
(n=86)
Week 24
(n=68)
Week 48
(n=62)
None
1
2-4
> 5
Decline to answer
0%
12%
55%...
wk 24 and wk 48 vs wk 0 p< 0.0001
wk 48 vs wk 24 NS
Unprotected intercourse over preceding 4 months
What is next?
Estimating the number of transmissions averted
through ART and behavioral change in AHI
David Wilson and col...
Discussion
 Initiation of ART during AHI may be a promising
intervention towards establishing functional HIV cure
 Sharp...
Discussion (cont.)
 Seminal VL peaks at 30 days post infection in
untreated subjects3 while in this cohort immediate
decl...
Conclusion
 Early ART greatly reduces infectiousness in AHI
 Impressive changes in risk behavior after ART and
risk redu...
Acknowledgements
the RV254/SEARCH010 study volunteers
Funding from US Military HIV Research Program
AFRIMS
o Alexandra Sch...
Acute HIV infection detection and control reduces HIV infectiousness and transmission risk behavior among men who have sex...
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Acute HIV infection detection and control reduces HIV infectiousness and transmission risk behavior among men who have sex with men in Bangkok, Thailand

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Acute HIV infection detection and control reduces HIV infectiousness and transmission risk behavior among men who have sex with men in Bangkok, Thailand

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Acute HIV infection detection and control reduces HIV infectiousness and transmission risk behavior among men who have sex with men in Bangkok, Thailand

  1. 1. Acute HIV infection detection and control reduces HIV infectiousness and transmission risk behavior among men who have sex with men in Bangkok, Thailand Frits van Griensven, Nittaya Phanuphak, Eugène Kroon, James Fletcher, Suteera Pinyakorn, Nitiya Chomchey, Siriwat Akapirat, Rapee Trichavaroj, Mark de Souza, Jerome Kim, and Jintanat Ananworanich, on behalf of the RV254/SEARCH 010 Study Group
  2. 2. Background  Antiretroviral treatment (ART) reduces HIV viral load and HIV transmission in HIV discordant heterosexual couples1 and likely MSM2  Despite increased uptake of ART since 1996, HIV incidence in MSM continues on a global level3  In rising and ongoing HIV epidemics in MSM, such as in Bangkok, most HIV transmission may occur prior to ART initiation4  Newly HIV infected MSM in Bangkok are mostly young men in a multi risk factor environment, which includes unidentified acute and newly HIV infected other MSM5  Phylogenetic clustering of new HIV infections in MSM supports acute HIV infection as one of the main drivers of ongoing HIV transmission in MSM in rising and ongoing HIV epidemics4,6,7 1Cohen et al. N Engl J Med 2011;365:493-505 (HPTN052); 2Porco et al. AIDS 2004;18:81-88; 3Beyrer et al. Lancet 2012;380:367-77; 4 Fisher et al. AIDS 2010; 24(11):1739-47; 5van Griensven et al. AIDS 2013;27(5):825-32; 6Audelin et al. J Acquir Immune Defic Syndr 2013;62(1):102-8; 7Ye J, et al. PLoS ONE 2013;8(1): e54238. doi:10.1371/journal.pone.0054238
  3. 3. RV254/SEARCH010 Study A cohort of individuals in acute HIV infection (AHI) in Bangkok, Thailand Purpose: Describe clinical, immunological, and virological characteristics during AHI for vaccine development and (functional) HIV cure insights Describe demographics and behavioral risk factors for those identified with acute HIV infection Intervention: Immediate initiation of ART upon detection of AHI Behavioral risk reduction counseling Outcomes: Markers of HIV disease progression or cure Behavioral change
  4. 4. Screening EIA/NAT 69,911 samples 136 AHI identified April 2009-March 2013 90 MSM in AHI identified 90% undetectable integrated HIV-DNA in PBMC at 1 year Candidates for functional cure research screening 3 days 36 not included in study 10 non-MSM To be reported elsewhere Here we look at reduction in HIV VL and transmission risk behavior to assess possible impact of AHI control on epidemic spread 88 MSM started ART 2 days after study entry RV254/SEARCH010 Study
  5. 5. Baseline Characteristics (n=88) Values Mean (SD) age 28.5 (7.0) years Mean (SD) duration of infection 16.5 (6.6) days 4th Gen staging Stage 1 (NAT+, 4th gen-, 3rd gen-) Stage 2 (NAT+, 4th gen+, 3rd gen-) Stage 3 (NAT+, 4th gen+, 3rd gen+, WB- or WB ind) 19 (21.6%) 21 (23.9%) 48 (54.6%) Mean CD4 (SD), cells/mm3 412 (189) Mean HIV RNA (SD), log10 copies/ml Plasma (n=88) Seminal plasma (n=47) Anal lavage (n=58) 5.62 (1.00) 4.02 (1.30) 2.58 (0.76) HIV-1 subtype CRF_01AE 73%
  6. 6. Baseline Behavioral Characteristics (n=86) Values Mean (SD) age at first sexual intercourse (years) 18.5 (2.5) Sexual Partners in last 4 months None 1 2-4 > 5 Decline to answer 0% 12% 55% 30% 5% Any unprotected sexual intercourse in 4 months prior to study entry 83.7% With: Regular Partner Casual Partner Commercial Sex Worker Person who gives money/goods IDU partner 64% 57% 7% 7% 11%
  7. 7. Blood plasma viral load
  8. 8. Beyond week 2: If blood plasma VL < detection, also seminal plasma VL < detection Seminal plasma viral load
  9. 9. Anal lavage viral load
  10. 10. Sexual Partners in last 4 months Baseline (n=86) Week 24 (n=68) Week 48 (n=62) None 1 2-4 > 5 Decline to answer 0% 12% 55% 30% 5% 18% 34% 32% 7% 9% 11% 34% 34% 13% 8% All wk 24 and wk 48 changes from baseline p<0.05 Changes from wk 24 to wk 48 NS Reported number of sexual partners
  11. 11. wk 24 and wk 48 vs wk 0 p< 0.0001 wk 48 vs wk 24 NS Unprotected intercourse over preceding 4 months
  12. 12. What is next? Estimating the number of transmissions averted through ART and behavioral change in AHI David Wilson and colleagues Kirby Institute University of New South Wales
  13. 13. Discussion  Initiation of ART during AHI may be a promising intervention towards establishing functional HIV cure  Sharp and rapid decreases in HIV blood plasma VL and seminal plasma VL are seen, which translate into potent HIV transmission reduction  Impressive behavioral changes during the early stages after AHI diagnosis, ART initiation and risk reduction counseling  Impact of early ART during AHI on transmission likely depends on the HIV epidemic stage; literature puts HIV transmissions resulting from AHI partners anywhere from 4% to 50%1,2 1Goodreau et al. PLoS ONE 2012;7(11): e50522; 2Brenner et al. J Infect Dis 2007;195:951-9
  14. 14. Discussion (cont.)  Seminal VL peaks at 30 days post infection in untreated subjects3 while in this cohort immediate decline was seen on ART and 73% VL < detection at week 4  Near 100% undetectable VL in seminal plasma at weeks 12 and 24 plus 100% correlation with blood plasma VL This contrasts with seminal plasma VL studies in North American MSM with undetectable blood plasma VL on ART4,5 3Pilcher et al. AIDS 2007;21:1723-30 4Politch et al. AIDS 2012;26:1535-43 5Sheth et al. AIDS 2009;23:2050-4
  15. 15. Conclusion  Early ART greatly reduces infectiousness in AHI  Impressive changes in risk behavior after ART and risk reduction counseling initiation, sustained up to 48 weeks  AHI detection and control may be a powerful HIV prevention measure in rising and ongoing HIV epidemics in MSM
  16. 16. Acknowledgements the RV254/SEARCH010 study volunteers Funding from US Military HIV Research Program AFRIMS o Alexandra Schuetz o Vatcharain Assawadarachai o Yuwadee Phuangngern o Wiriya Rutvisuttinunt o Nantana Tantibul o Panadda Sawangsinth o Bessara Nuntapinit o Wanwarang Khobchit o Sakuna Suksawad o Ajchariyarat Sangdara o Kultida Poltavee o Hathairat Savadsuk o Suwittra Chaemchuen o Robert Paris o Surat Jongrakthaitae o Chayada Sajiaweerawan o Nipattra Tragonlugsana o Putida Saetun UCSF o Victor Valcour Yale o Serena Spudich o Idil Kore Kirby o David Wilson o Lei Zhang o Andrew Shattock Thai Red Cross/Chula o Praphan Phanuphak o Thep Chalermchai o Nipat Teeratakulpisarn o Rungsun Rerknimitr o Wiriyaporn Ridtitid o Sukalya Lerdlum o Duanghathai Suttichom o Somprartthana Rattanamanee o Peeraya Mangu o Sasiwimol Ubolyam o Mantana Pothisri NIAID o Irini Sereti o Daniel Douek o Netanya Sandler o Mary Marovich NCI o Jacob Estes o Robin Dewar o Adam Rupert SAIC-Frederick o Frank Maldarelli o Mary Kearney o Ann Wiggins Huntington Memorial o Napaporn Sailasuta VGTI o Elias Haddad o Lydie Trautmann WRAIR o Bonnie Slike o Sodsai Tovanabutra o Gustavo Kijak Industry o Thai GPO (TDF, 3TC, EFV, LPV/r) o Gilead (TDF, FTC) o Merck (EEV, RAL) o Pfizer (MVC) o Monogram (Trofile)

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