HIV patients on ART still feel infectious despite low viral loads

BOSTON — Just 10% of HIV patients reported feeling noninfectious about 1 year into ART despite a high rate of viral suppression, according to study data presented at CROI 2016.

“We think this highlights some important opportunities for finding populations who need more education about what it means for their sexual partners in terms of their infectiousness by a sexual route as they initiate therapy,” Raphael J. Landovitz, MD, of the Center for Clinical AIDS Research and Education at the David Geffen School of Medicine at UCLA, said at a press conference. “I think as providers we can do a better job about contextualizing the benefits of antiretroviral therapy, not only for individuals, but for populations.”

Raphael J. Landovitz

Landovitz and colleagues studied 1,809 ART-naive patients in a randomized, open-label ART study for up to 192 weeks who self-assessed their perception of infectiousness (POI) on a scale of 0 to 100. Before beginning ART, 6% of patients viewed themselves as noninfectious — a 0 on the scale. Ten percent reported feeling a low POI (1-33); 26% reported medium POI (34-66); and 58% — “probably accurately,” according to Landovitz — categorized themselves as highly infectious (67-100).

After 48 weeks, 91% had virologic suppression, considered HIV RNA less than 50 cells/mL, and 49% reported a reduction in POI from baseline, categorized as at least a 10-point decrease. However, only 10% viewed themselves as noninfectious. Younger, better-educated patients and those with a higher baseline POI were more likely to report a decline in POI, Landovitz and colleagues noted. Non-Hispanic blacks, those who were less immunosuppressed before ART initiation and less educated patients were not as likely to perceive a decline in infectiousness.

Ninety-nine patients reported a reduction of POI to noninfectious — 7.6% of the population studied — with baseline POI, female sex and the absence of stimulant drug use cited as factors in that decline. Around only 8% of those patients had not achieved virologic suppression.

“Initiation of ART presents not only an opportunity to preserve someone’s own immune health, but to prevent spread of HIV to sexual partners — and providers should take the opportunity to counsel patients about the dramatic reduction in ‘infectivity’ with which viral suppression is associated,” Landovitz told Infectious Disease News. – by Gerard Gallagher

Reference:

Landovitz RJ, et al. Abstract 55. Presented at: Conference on Retroviruses and Opportunistic Infections; Feb. 22-25, 2016; Boston.

Disclosure: Landovitz reports receiving consulting fees, travel and drug supply from Gilead Sciences.

Conference on Retroviruses and Opportunistic Infections (CROI)

HIV patients on ART still feel infectious despite low viral loads