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Behavioral changes following HIV seroconversion during the historical expansion of HIV treatment in the United States.

ABSTRACT: OBJECTIVES:To identify the ways in which HIV seroconversion impacts subsequent health behaviors in the context of evolving HIV treatment technologies. DESIGN:Prospective cohort study. METHODS:We assessed changes in health and HIV risk behaviors following HIV seroconversion both before and after HIV treatment access (i.e. HAART) in the United States by drawing from the Multicenter AIDS Cohort Study, which collected data from men who have sex with men (MSM) (n?=?4616) in four US cities from 1984 to 2008. Longitudinal regression analyses with individual fixed effects accounted for time-invariant, unobservable determinants of risk behaviors. Further analyses assessed the sensitivity of our results to controlling for indicators of physical and mental health (e.g. CD4 cell count, depression) and differential attrition by higher risk individuals. RESULTS:Among those who seroconverted during observation (n?=?558), HIV seroconversion was associated with reduced odds of subsequent engagement in sex with at least two partners [adjusted odds ratio [adjusted odds ratio (aOR): 0.371; confidence interval (CI): 0.263-0.523], insertive anal sex with at least two partners (aOR: 0.360; CI: 0.219-0.591), and heavy drinking (aOR: 0.704; CI: 0.508-0.977). Seroconversion after HAART availability and treatment initiation was associated with further reduced odds of engaging in these behaviors. CD4 cell count, depression, and attrition did not change these results. CONCLUSION:Specific health and HIV risk behaviors declined following seroconversion, especially with treatment availability and utilization. These positive behavior changes following HIV seroconversion provide evidence for continued investment in the HIV care continuum, including support for HIV testing and engagement in clinical care and treatment.

SUBMITTER: Zhu W

PROVIDER: S-EPMC6475119 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

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Behavioral changes following HIV seroconversion during the historical expansion of HIV treatment in the United States.

Zhu Wenjia W Bazzi Samuel A SA Bazzi Angela R AR

AIDS (London, England) 20190101 1

<h4>Objectives</h4>To identify the ways in which HIV seroconversion impacts subsequent health behaviors in the context of evolving HIV treatment technologies.<h4>Design</h4>Prospective cohort study.<h4>Methods</h4>We assessed changes in health and HIV risk behaviors following HIV seroconversion both before and after HIV treatment access (i.e. HAART) in the United States by drawing from the Multicenter AIDS Cohort Study, which collected data from men who have sex with men (MSM) (n = 4616) in four ...[more]

PMID: 30325770

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Project description:A robust method for characterizing the biophysical environment of terrestrial vegetation uses the relationship between Actual Evapotranspiration (AET) and Climatic Water Deficit (CWD). These variables are usually estimated from a water balance model rather than measured directly and are often more representative of ecologically-significant changes than temperature or precipitation. We evaluate trends and spatial patterns in AET and CWD in the Continental United States (CONUS) during 1980-2019 using a gridded water balance model. The western US had linear regression slopes indicating increasing CWD and decreasing AET (drying), while the eastern US had generally opposite trends. When limits to plant performance characterized by AET and CWD are exceeded, vegetation assemblages change. Widespread increases in aridity throughout the west portends shifts in the distribution of plants limited by available moisture. A detailed look at Sequoia National Park illustrates the high degree of fine-scale spatial variability that exists across elevation and topographical gradients. Where such topographical and climatic diversity exists, appropriate use of our gridded data will require sub-setting to an appropriate area and analyzing according to categories of interest such as vegetation communities or across obvious physical gradients. Recent studies have successfully applied similar water balance models to fire risk and forest structure in both western and eastern U.S. forests, arid-land spring discharge, amphibian colonization and persistence in wetlands, whitebark pine mortality and establishment, and the distribution of arid-land grass species and landscape scale vegetation condition. Our gridded dataset is available free for public use. Our findings illustrate how a simple water balance model can identify important trends and patterns at site to regional scales. However, at finer scales, environmental heterogeneity is driving a range of responses that may not be simply characterized by a single trend.

Project description:BackgroundLittle is known regarding HIV disease outcomes among individuals who become infected with HIV while receiving antiretroviral medications for prevention. We compared HIV disease parameters among women who seroconverted while receiving tenofovir-containing oral or vaginal pre-exposure prophylaxis (PrEP) to placebo.MethodsParticipants with HIV seroconversion in a randomized placebo-controlled trial of oral tenofovir, oral tenofovir/emtricitabine, and vaginal tenofovir gel (MTN-003) were followed in a longitudinal cohort study (MTN-015). The effect of oral and vaginal tenofovir-containing PrEP on HIV disease progression was compared to placebo using linear mixed effects and Cox proportional hazard models, as appropriate. Additional analyses were performed to compare the outcomes among participants with detectable tenofovir or emtricitabine in plasma at the first quarterly visit in MTN-003.ResultsA total of 224 participants were included in the analysis; 93% from South Africa and 94% clade C virus. No differences in HIV RNA at steady state or the trajectory over 12 months were observed for each active arm compared to placebo; tenofovir gel recipients had higher CD4+ T cell counts (722 vs 596 cells/mm3; p = 0.02) at 90 days after estimated HIV seroconversion and higher average rates of change over 12 months compared to placebo (-181 vs -92 cells/mm3 per year; p = 0.08). With a median follow-up of 31 months, no significant differences were observed for time to CD4+ T cell count ≤350 cells/mm3, or the composite endpoint of CD4+ T cells ≤350 cells/mm3, initiation of antiretroviral therapy or death for each active arm compared to placebo. Additionally, there were no significant differences in the HIV RNA or CD4+ T cell counts at baseline, the change to month 12, or any disease progression outcomes among participants with oral drug detected and no oral drug detected compared to placebo.ConclusionsNo clinically significant differences in HIV seroconversion outcomes were observed among women randomized to tenofovir-containing oral or vaginal PrEP regimens, however low overall adherence limits the generalizability of these findings.

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Behavioral changes following HIV seroconversion during the historical expansion of HIV treatment in the United States.

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Behavioral changes following HIV seroconversion during the historical expansion of HIV treatment in the United States.

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