The expected impact of a cure for HIV among people with HIV and key populations

Abstract

Background: This study explored the expected impact of two hypothetical HIV cure scenarios on quality of life, sexual satisfaction, and stigma among people with HIV and key populations (i.e., partners and communities of people with HIV and men who have sex with men without HIV) in the Netherlands.

Methods: A cross-sectional survey was conducted among people with HIV and key populations from October 2021 until June 2022. We assessed quality of life, sexual satisfaction, and stigma using linear regression and mixed models to compare participants' current situation with two hypothetical HIV cure scenarios: HIV post-intervention control, where HIV is suppressed without the need for ongoing antiretroviral treatment, but the viral reservoir is expected to persist, and HIV elimination, where HIV is completely removed from the body.

Results: Our findings show that people with HIV (n = 222) expect improved quality of life and sexual satisfaction, as well as reduced stigma, compared to their current situation following both post-intervention control and elimination. Key populations (n = 495) similarly expect improvements for both HIV cure scenarios, except no expected improvement was found for quality of life following post-intervention control. Participants aged 18 to 34 anticipate greater improvements from both cure scenarios than those over 34.

Conclusions: Both people with HIV and key populations without HIV expect an HIV cure to have a positive impact on quality of life, sexual satisfaction, and stigma. This impact is expected not only for HIV elimination but also for HIV post-intervention control, the development of which appears more feasible.

Fig. 1. Expected change after cure: direct assessment of QoL.

X-axes represent percentages of participants who answered worse (black), same (light gray), or better (dark gray) for internalized stigma, mental health, social activities, physical health, and QoL after PIC or elimination. Panels a and b show the expected change among PHIV for PIC (n = 222) and elimination (n = 200). Panels c and d show the expected change among key populations for PIC (n = 495) and elimination (n = 443). PIC post-intervention control. QoL quality of life. Y-axes represent the following questions answered by participants: Internalized stigma: How would the degree to which you experience internalized stigma due to HIV change? Mental health: How would your mental health change? Social activities: How do you think that your social activities would change? Physical health: How would your general physical health change? QoL: How would your QoL change?

Fig. 2. Expected change after cure: QoL, sexual satisfaction, and stigma scales.

Y-axes represented the transformed Z scores of QoL, sexual satisfaction, and stigma scales. ^*All mean scores are transformed to Z scores to enable interpretation of expected change. Scores for current QoL, sexual satisfaction, and stigma differ slightly due to respondents who did not fully complete the survey (i.e., only completed sections I and II). Markers represent the regression coefficient from the mixed model analyses and represent mean differences in addition to group means. Gray circular markers represent PIC. Gray square markers indicate elimination. Panels a–c show the expected change among PHIV for PIC and elimination. Panels d–f show the expected change among key populations for PIC and elimination. Black error bars represent 95% confidence intervals. Supplementary Information, Supplementary Figs. 1–12 and Supplementary Information, Supplementary Tables 1–12 provide the individual absolute scores transformed to Z scores to enable further interpretation and transparency of Fig. 2. QoL Quality of life, PIC post-intervention control, VAS visual analog scale, N-SSSS New Scale of Sexual Satisfaction, HSS Berger stigma subscale: concerns with public attitudes towards PHIV.