Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2007 Apr 15;44(8):1115-22.
doi: 10.1086/512816. Epub 2007 Mar 9.

The effect of antiretroviral therapy on secondary transmission of HIV among men who have sex with men

Alethea W McCormick  1 , Rochelle P Walensky, Marc Lipsitch, Elena Losina, Heather Hsu, Milton C Weinstein, A David Paltiel, Kenneth A Freedberg, George R Seage 3rd
Affiliations

The effect of antiretroviral therapy on secondary transmission of HIV among men who have sex with men

Alethea W McCormick et al. Clin Infect Dis. .

Abstract

Background: Antiretroviral therapy (ART) reduces human immunodeficiency virus (HIV) RNA load and the probability of transmitting HIV to an HIV-uninfected partner. However, the potential reduction in secondary transmission associated with ART may be offset by the longer duration of infectiousness.

Methods: To estimate the effects of ART on the secondary transmission of HIV among men who have sex with men, we used a previously published state-transition model of HIV disease to simulate the clinical and virologic course of HIV infection among 2 cohorts of men who have sex with men: (1) a cohort of individuals who were not receiving ART and (2) a cohort of individuals treated with US guideline-concordant ART. The model tracked the number of acts of unprotected insertive anal intercourse, transmission risk per act as determined by HIV RNA level, and the number of secondary cases generated in each cohort.

Results: The estimated mean number of secondary transmissions from an HIV-infected individual after 10, 20, and 30 years of infection were 1.9, 2.5, and 2.5, respectively, in the untreated cohort, compared with 1.4, 1.8, and 2.3, respectively, in the treated cohort. The total number of transmissions for the treated cohort began to exceed the total number of transmissions for the untreated cohort 33 years after infection; over the entire course of infection, treatment with ART led to a 23% increase in secondary infections. All estimates of the impact of ART on secondary transmission were sensitive to changes in risk behaviors.

Conclusions: These results suggest that ART must be accompanied by effective HIV-related risk reduction interventions. Programs that target prevention to decrease further HIV transmission are crucial to epidemic control.

PubMed Disclaimer

Conflict of interest statement

Potential conflicts of interest. All authors: no conflicts.

Figures

Figure 1
Figure 1
The basic reproductive number (R0) by year in the untreated (thick blue line) and treated (red line) cohorts are shown to compare the time required to reach a given R0. The proportion of the original cohort that is alive in the untreated (thin blue line) and treated (pink line) cohort and the proportion of the original cohort receiving ART in the treated cohort (green line) are also shown. This graph is truncated at 60 years after infection.
See this image and copyright information in PMC

References

    1. Anderson DJ, Politch JA, O’Brien T, et al. Effects of disease stage and zidovudine therapy on the prevalence of HIV-1 in semen. JAMA. 1992;267:2769–74. - PubMed
    1. Vernazza PL, Troiani L, Flepp MJ, et al. Potent antiretroviral treatment of HIV-infection results in suppression of the seminal shedding of HIV. AIDS. 2000;14:117–21. - PubMed
    1. Mayer KH, Boswell S, Goldstein R, et al. Persistence of human immunodeficiency virus in semen after adding indinavir to combination antiretroviral therapy. Clin Infect Dis. 1999;28:1252–9. - PubMed
    1. Quinn TC, Wawer MJ, Sewankambo N, et al. Viral load and heterosexual transmission of human immunodeficiency virus type 1. New Engl J Med. 2000;342:921–9. - PubMed
    1. Tovanabutra S, Robison V, Wongtrakul J, et al. Male viral load and heterosexual transmission of HIV-1 subtype E in northern Thailand. J Acquir Immun Defic Syndr. 2002;29:275–83. - PubMed

Publication types

Substances