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The TasP Revolution

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HIV Treatments as Prevention (TasP)

Part of the book series: SpringerBriefs in Public Health ((BRIEFSPUBLIC))

Abstract

Antiretroviral medications are effective in treating HIV infection and are now being used for prevention. The basis for treatment as prevention (TasP) relies on reducing concentrations of HIV in infected persons to the point where they are less infectious. Research has shown that TasP can work, including definitive evidence from clinical trials. There are, however, points of vulnerability by which TasP can fail. This chapter examines these vulnerabilities and offers behavioral strategies to bolster the success of TasP. Optimal implementation of TasP will require minimizing the risks posed by acute HIV infection, assuring treatment adherence, correcting misperceptions and false beliefs about HIV infectiousness, and controlling sexually transmitted coinfections. Three evidence-based interventions that integrate risk reduction counseling and medication adherence are discussed as implementation ready for TasP.

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References

  1. Cohen MS, Shaw GM, McMichael AJ, Haynes BF. Acute HIV-1 infection. N Engl J Med. 2011;364(20):1943–54. Epub 20 May 2011.

    Article  PubMed  Google Scholar 

  2. Connor EM, Sperling RS, Gelber R, Kiselev P, Scott G, O’Sullivan MJ, et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. Pediatric AIDS Clinical Trials Group Protocol 076 Study Group. N Engl J Med. 1994;331(18):1173–80. Epub 3 Nov 1994.

    Article  PubMed  Google Scholar 

  3. Trust NA. HIV treatment as prevention. UK: National AIDS Trust; 2011.

    Google Scholar 

  4. Padian NS. Sexual histories of heterosexual couples with one HIV-infected partner. Am J Public Health. 1990;80(8):990–1. Epub 1 Aug 1990.

    Article  PubMed  Google Scholar 

  5. Cohen MS, Hoffman IF, Royce RA, Kazembe P, Dyer JR, Daly CC, et al. Reduction of concentration of HIV-1 in semen after treatment of urethritis: implications for prevention of sexual transmission of HIV-1. AIDSCAP Malawi Research Group. Lancet. 1997;349(9069):1868–73. Epub 28 June 1997.

    Article  PubMed  Google Scholar 

  6. Steward WT, Remien RH, Higgins JA, Dubrow R, Pinkerton SD, Sikkema KJ, et al. Behavior change following diagnosis with acute/early HIV infection—a move to serosorting with other HIV-infected individuals. The NIMH Multisite Acute HIV Infection Study: III. AIDS Behav. 2009;13(6):1054–60. Epub 9 June 2009.

    Article  PubMed  Google Scholar 

  7. Wawer MJ, Gray RH, Sewankarnbo NK, Serwadda D, Li X, Laeyendecker O, et al. Rates of HIV-1 transmission per coital act, by stage of HIV-1 infection, in Rakai, Uganda. J Infect Dis. 2005;191(9):1403–9.

    Article  PubMed  Google Scholar 

  8. Mehta SD, Gray RH, Auvert B, Moses S, Kigozi G, Taljaard D, et al. Does sex in the early period after circumcision increase HIV-seroconversion risk? Pooled analysis of adult male circumcision clinical trials. AIDS. 2009;23(12):1557–64. Epub 3 July 2009.

    Article  PubMed  Google Scholar 

  9. Cohen MS, Hosseinipour M. HIV treatment meets prevention: antiretroviral therapy as prophylaxis. In: M P, editor. The AIDS pandemic: impact on science and society. New York: Elsevier; 2004.

    Google Scholar 

  10. Kalichman SC, Simbayi LC. Sexual exposure to blood and behavioural risks among STI clinic patients in Cape Town, South Africa. Sex Health. 2005;2(2):85–8. Epub 14 Dec 2005.

    Article  PubMed  Google Scholar 

  11. Kalichman SC, Simbayi LC, Cain D, Cherry C, Jooste S. Coital bleeding and HIV risks among men and women in Cape Town, South Africa. Sex Transm Dis. 2006;33(9):551–7. Epub 12 May 2006.

    Article  PubMed  Google Scholar 

  12. Kalichman SC, Cain D, Simbayi LC. Behavioral changes associated with testing HIV-positive among sexually transmitted infection clinic patients in Cape Town, South Africa. Am J Public Health. 2010;100(4):714–9. Epub 20 Feb 2010.

    Article  PubMed  Google Scholar 

  13. Boily MC, Baggaley RF, Wang L, Masse B, White RG, Hayes RJ, et al. Heterosexual risk of HIV-1 infection per sexual act: systematic review and meta-analysis of observational studies. Lancet Infect Dis. 2009;9(2):118–29. Epub 31 Jan 2009.

    Article  PubMed  Google Scholar 

  14. Powers KA, Ghani AC, Miller WC, Hoffman IF, Pettifor AE, Kamanga G, et al. The role of acute and early HIV infection in the spread of HIV and implications for transmission prevention strategies in Lilongwe, Malawi: a modelling study. Lancet. 2011;378(9787):256–68. Epub 21 June 2011.

    Article  PubMed  Google Scholar 

  15. Coates TJ, Stall RD, Catania JA, Kegeles SM. Behavioral factors in the spread of HIV infection. AIDS. 1988;2 Suppl 1:S239–46. Epub 1 Jan 1988.

    Article  PubMed  Google Scholar 

  16. Stall RD, Coates TJ, Hoff C. Behavioral risk reduction for HIV infection among gay and bisexual men. A review of results from the United States. Am Psychol. 1988;43(11):878–85. Epub 1 Nov 1988.

    Article  PubMed  Google Scholar 

  17. Lescano CM, Houck CD, Brown LK, Doherty G, DiClemente RJ, Fernandez MI, et al. Correlates of heterosexual anal intercourse among at-risk adolescents and young adults. Am J Public Health. 2009;99(6):1131–6. Epub 15 Nov 2008.

    Article  PubMed  Google Scholar 

  18. Mosher WD, Chandra A, Jones J. Sexual behavior and selected health measures: men and women 15–44 years of age, United States, 2002. Adv Data. 2005;362:1–55. Epub 28 Oct 2005.

    PubMed  Google Scholar 

  19. Kalichman SC, Simbayi LC, Cain D, Jooste S. Heterosexual anal intercourse among community and clinical settings in Cape Town, South Africa. Sex Transm Infect. 2009;85(6):411–5. Epub 12 May 2009.

    Article  PubMed  Google Scholar 

  20. Kalichman SC, Pinkerton SD, Carey MP, Cain D, Mehlomakulu V, Carey KB, et al. Heterosexual anal intercourse and HIV infection risks in the context of alcohol serving venues, Cape Town, South Africa. BMC Public Health. 2011;11:807. Epub 18 Oct 2011.

    Article  PubMed  Google Scholar 

  21. Fang CT, Hsu HM, Twu SJ, Chen MY, Chang YY, Hwang JS, et al. Decreased HIV transmission after a policy of providing free access to highly active antiretroviral therapy in Taiwan. J Infect Dis. 2004;190(5):879–85. Epub 6 Aug 2004.

    Article  PubMed  Google Scholar 

  22. Baeten JM, Kahle E, Lingappa JR, Coombs RW, Delany-Moretlwe S, Nakku-Joloba E, et al. Genital HIV-1 RNA predicts risk of heterosexual HIV-1 transmission. Sci Transl Med. 2011;3(77):77ra29. Epub 8 Apr 2011.

    Article  PubMed  Google Scholar 

  23. Pao D, Pillay D, Fisher M. Potential impact of early antiretroviral therapy on transmission. Curr Opin HIV AIDS. 2009;4(3):215–21. Epub 18 June 2009.

    Article  PubMed  Google Scholar 

  24. Attia S, Egger M, Muller M, Zwahlen M, Low N. Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis. AIDS. 2009;23(11):1397–404. Epub 22 Apr 2009.

    Article  PubMed  Google Scholar 

  25. Hull MW, Montaner J. Antiretroviral therapy: a key component of a comprehensive HIV prevention strategy. Curr HIV/AIDS Rep. 2011;8(2):85–93. Epub 30 Mar 2011.

    Article  PubMed  Google Scholar 

  26. Smith K, Powers KA, Kashuba AD, Cohen MS. HIV-1 treatment as prevention: the good, the bad, and the challenges. Curr Opin HIV AIDS. 2011;6(4):315–25. Epub 8 June 2011.

    PubMed  Google Scholar 

  27. Cowan SA, Gerstoft J, Haff J, Hartvig Christiansen A, Statistician JN, Obel N. Stable incidence of HIV diagnoses among Danish MSM despite increased engagement in unsafe sex. J Acquir Immune Defic Syndr. 2012. Epub 18 May 2012.

    Google Scholar 

  28. Jin F, Jansson J, Law M, Prestage GP, Zablotska I, Imrie JC, et al. Per-contact probability of HIV transmission in homosexual men in Sydney in the era of HAART. AIDS. 2010;24(6):907–13. Epub 9 Feb 2010.

    Article  PubMed  Google Scholar 

  29. Granich RM, Gilks CF, Dye C, De Cock KM, Williams BG. Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. Lancet. 2009;373(9657):48–57. Epub 29 Nov 2008.

    Article  PubMed  Google Scholar 

  30. Dieffenbach CW, Fauci AS. Universal voluntary testing and treatment for prevention of HIV transmission. JAMA. 2009;301(22):2380–2. Epub 11 June 2009.

    Article  PubMed  Google Scholar 

  31. Hallett TB, Smit C, Garnett GP, de Wolf F. Estimating the risk of HIV transmission from homosexual men receiving treatment to their HIV-uninfected partners. Sex Transm Infect. 2011;87(1):17–21. Epub 21 July 2010.

    Article  PubMed  Google Scholar 

  32. Cohen MS, McCauley M, Gamble TR. HIV treatment as prevention and HPTN 052. Curr Opin HIV AIDS. 2012;7(2):99–105. Epub 10 Jan 2012.

    Article  PubMed  Google Scholar 

  33. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505. Epub 20 July 2011.

    Article  PubMed  Google Scholar 

  34. Cohen MS, Gay CL. Treatment to prevent transmission of HIV-1. Clin Infect Dis. 2010;50 Suppl 3:S85–95. Epub 20 Apr 2010.

    Article  PubMed  Google Scholar 

  35. Vernazza PL, Eron JJ, Cohen MS, van der Horst CM, Troiani L, Fiscus SA. Detection and biologic characterization of infectious HIV-1 in semen of seropositive men. AIDS. 1994;8(9):1325–9. Epub 1 Sept 1994.

    Article  PubMed  Google Scholar 

  36. Vernazza PL, Gilliam BL, Flepp M, Dyer JR, Frank AC, Fiscus SA, et al. Effect of antiviral treatment on the shedding of HIV-1 in semen. AIDS. 1997;11(10):1249–54. Epub 1 Aug 1997.

    Article  PubMed  Google Scholar 

  37. Vernazza PL, Troiani L, Flepp MJ, Cone RW, Schock J, Roth F, et al. Potent antiretroviral treatment of HIV infection results in suppression of the seminal shedding of HIV. AIDS. 2000;14(2):117–21.

    Article  PubMed  Google Scholar 

  38. Vernazza P, Hirschel B, Bernasconi E, Flepp M. HIV-positive individuals without additional sexually transmitted diseases (STD) and on effective anti-retroviral therapy are sexually non-infectious. Bulletin des médecins suisses 2008;89(5).

    Google Scholar 

  39. Strub S. Swiss say condoms not necessary…sometimes. Huffington Post. 2012.

    Google Scholar 

  40. WHO-UNAIDS. Antiretroviral therapy and sexual transmission of HIV. UNAIDS. 2008.

    Google Scholar 

  41. Pinkerton SD. How many sexually-acquired HIV infections in the USA are due to acute-phase HIV transmission? AIDS. 2007;21(12):1625–9. Epub 17 July 2007.

    Article  PubMed  Google Scholar 

  42. Cohen MS. HIV treatment as prevention and “the Swiss statement”: in for a dime, in for a dollar? Clin Infect Dis. 2010;51(11):1323–4. Epub 3 Nov 2010.

    Article  PubMed  Google Scholar 

  43. Kalichman SC, Di Berto G, Eaton L. Human immunodeficiency virus viral load in blood plasma and semen: review and implications of empirical findings. Sex Transm Dis. 2008;35(1):55–60. Epub 25 Jan 2008.

    Article  PubMed  Google Scholar 

  44. Hosein S, Wilson D. Decision-making by people living with HIV requires communication from clinicians about the risks of transmission despite undetectable plasma viral load. HIV Med. 2010;12:516.

    Article  Google Scholar 

  45. Kalichman SC, Cage M, Barnett T, Tharnish P, Rompa D, Austin J, et al. Human immunodeficiency virus in semen and plasma: investigation of sexual transmission risk behavioral correlates. AIDS Res Hum Retroviruses. 2001;17(18):1695–703. Epub 15 Jan 2002.

    Article  PubMed  Google Scholar 

  46. Cu-Uvin S, Hogan JW, Caliendo AM, Harwell J, Mayer KH, Carpenter CC. Association between bacterial vaginosis and expression of human immunodeficiency virus type 1 RNA in the female genital tract. Clin Infect Dis. 2001;33(6):894–6. Epub 21 Aug 2001.

    Article  PubMed  Google Scholar 

  47. Vernazza P, Kashuba A, Cohen MS. Biological correlates of sexual transmission of HIV: practical consequences and potential targets for public health. Rev Med Microbiol. 2001;12(3):131–42.

    Article  Google Scholar 

  48. Reichelderfer PS, Coombs RW, Wright DJ, Cohn J, Burns DN, Cu-Uvin S, et al. Effect of menstrual cycle on HIV-1 levels in the peripheral blood and genital tract WHS 001 Study Team. AIDS. 2000;14(14):2101–7. Epub 4 Nov 2000.

    Article  PubMed  Google Scholar 

  49. Kalichman SC, Eaton L, Cherry C. Sexually transmitted infections and infectiousness beliefs among people living with HIV/AIDS: implications for HIV treatment as prevention. HIV Med. 2010;11(8):502–9. Epub 6 Mar 2010.

    PubMed  Google Scholar 

  50. Kalichman SC, Rompa D, Austin J, Luke W, DiFonzo K. Viral load, perceived infectivity, and unprotected intercourse. J Acquir Immune Defic Syndr. 2001;28(3):303–5. Epub 6 Nov 2001.

    PubMed  Google Scholar 

  51. Hasse B, Ledergerber B, Hirschel B, Vernazza P, Glass TR, Jeannin A, et al. Frequency and determinants of unprotected sex among HIV-infected persons: the Swiss HIV cohort study. Clin Infect Dis. 2010;51(11):1314–22. Epub 3 Nov 2010.

    Article  PubMed  Google Scholar 

  52. Johnson LF, Lewis DA. The effect of genital tract infections on HIV-1 shedding in the genital tract: a systematic review and meta-analysis. Sex Transm Dis. 2008;35(11):946–59. Epub 8 Aug 2008.

    Article  PubMed  Google Scholar 

  53. Kalichman SC, Pellowski J, Turner C. Prevalence of sexually transmitted co-infections in people living with HIV/AIDS: systematic review with implications for using HIV treatments for prevention. Sex Transm Infect. 2011;87(3):183–90. Epub 19 Feb 2011.

    Article  PubMed  Google Scholar 

  54. Holtgrave DR, Maulsby C, Wehrmeyer L, Hall HI. Behavioral factors in assessing impact of HIV treatment as prevention. AIDS Behav. 2012;16(5):1085–91. Epub 12 Apr 2012.

    Article  PubMed  Google Scholar 

  55. Holtgrave DR, Hall HI, Wehrmeyer L, Maulsby C. Costs, consequences and feasibility of strategies for achieving the goals of the National HIV/AIDS Strategy in the United States: a closing window for success? AIDS Behav. 2012. Epub 23 May 2012.

    Google Scholar 

  56. Kurth AE, McClelland L, Wanje G, Ghee AE, Peshu N, Mutunga E, et al. An integrated approach for antiretroviral adherence and secondary HIV transmission risk-reduction support by nurses in Kenya. J Assoc Nurses AIDS Care. 2012;23(2):146–54. Epub 2 Aug 2011.

    Article  PubMed  Google Scholar 

  57. Ewart C. Social action theory for a public health psychology. Am Psychol. 1991;465:931–46.

    Article  Google Scholar 

  58. Ewart C. How integrative behavioral theory can improve health promotion and disease prevention. In: Boll TJ, Frank RG, Baum A, Wallander J, editors. Handbook of health psychology. Washington, DC: American Psychological Association; 2004.

    Google Scholar 

  59. Gore-Felton C, Rotheram-Borus MJ, Weinhardt LS, Kelly JA, Lightfoot M, Kirshenbaum SB, et al. The Healthy Living Project: an individually tailored, multidimensional intervention for HIV-infected persons. AIDS Educ Prev. 2005;17(1 Suppl A):21–39. Epub 22 Apr 2005.

    Article  PubMed  Google Scholar 

  60. Chesney MA, Chambers DB, Taylor JM, Johnson LM, Folkman S. Coping effectiveness training for men living with HIV: results from a randomized clinical trial testing a group-based intervention. Psychosom Med. 2003;65(6):1038–46. Epub 4 Dec 2003.

    Article  PubMed  Google Scholar 

  61. Chesney M, Folkman S, Chambers D. Coping effectiveness training for men living with HIV: preliminary findings. Int J STD AIDS. 1996;7 Suppl 2:75–82. Epub 1 Jan 1996.

    Article  PubMed  Google Scholar 

  62. Healthy Living Project Team. Effects of a behavioral intervention to reduce risk of transmission among people living with HIV: the healthy living project randomized controlled study. J Acquir Immune Defic Syndr. 2007;44(2):213–21. Epub 6 Dec 2006.

    Article  Google Scholar 

  63. Johnson MO, Charlebois E, Morin SF, Remien RH, Chesney MA. Effects of a behavioral intervention on antiretroviral medication adherence among people living with HIV: the healthy living project randomized controlled study. J Acquir Immune Defic Syndr. 2007;46(5):574–80. Epub 15 Jan 2008.

    Article  PubMed  Google Scholar 

  64. Pinkerton SD, Holtgrave DR, Valdiserri RO. Cost-effectiveness of HIV-prevention skills training for men who have sex with men. AIDS. 1997;11(3):347–57. Epub 1 Mar 1997.

    Article  PubMed  Google Scholar 

  65. Pinkerton SD, Holtgrave DR. How HIV treatment advances affect the cost-effectiveness of prevention. Med Decis Making. 2000;20(1):89–94. Epub 19 Jan 2000.

    Article  PubMed  Google Scholar 

  66. Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot. 1997;12(1):38–48. Epub 5 Aug 1997.

    Article  PubMed  Google Scholar 

  67. Miller WR, Rose GS. Toward a theory of motivational interviewing. Am Psychol. 2009;64(6):527–37. Epub 11 Sept 2009.

    Article  PubMed  Google Scholar 

  68. Holstad M, DiIorio C, Magowe M. Motivating HIV positive women to adhere to antiretroviral therapy and risk reduction behavior: The KHARMA Project. J Issues Nurs. 2006;11:1–19.

    Google Scholar 

  69. Holstad MM, DiIorio C, Kelley ME, Resnicow K, Sharma S. Group motivational interviewing to promote adherence to antiretroviral medications and risk reduction behaviors in HIV infected women. AIDS Behav. 2011;15(5):885–96. Epub 18 Nov 2010.

    Article  PubMed  Google Scholar 

  70. Kalichman SC, Cherry C, Kalichman MO, Amaral CM, White D, Pope H, et al. Integrated behavioral intervention to improve HIV/AIDS treatment adherence and reduce HIV transmission. Am J Public Health. 2011;101(3):531–8. Epub 15 Jan 2011.

    Article  PubMed  Google Scholar 

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Kalichman, S.C. (2013). The TasP Revolution. In: HIV Treatments as Prevention (TasP). SpringerBriefs in Public Health. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5119-8_3

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  • DOI: https://doi.org/10.1007/978-1-4614-5119-8_3

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