Progression and Transmission of HIV/AIDS (PATH 2.0)

Background. HIV transmission is the result of complex dynamics in the risk behaviors, partnership choices, disease stage and position along the HIV care continuum—individual characteristics that themselves can change over time. Capturing these dynamics and simulating transmissions to understand the chief sources of transmission remain important for prevention. Methods. The Progression and Transmission of HIV/AIDS (PATH 2.0) is an agent-based model of a sample of 10,000 people living with HIV (PLWH), who represent all men who have sex with men (MSM) and heterosexuals living with HIV in the U.S.A. Persons uninfected were modeled as populations, stratified by risk and gender. The model included detailed individual-level data from several large national surveillance databases. The outcomes focused on average annual transmission rates from 2008 through 2011 by disease stage, HIV care continuum, and sexual risk group. Results. The relative risk of transmission of those in the acute phase was nine-times [5th and 95th percentile simulation interval (SI): 7, 12] that of those in the non-acute phase, although, on average, those with acute infections comprised 1% of all PLWH. The relative risk of transmission was 24- to 50-times as high for those in the non-acute phase who had not achieved viral load suppression as compared with those who had. The relative risk of transmission among MSM was 3.2-times [SI: 2.7, 4.0] that of heterosexuals. Men who have sex with men and women generated 46% of sexually acquired transmissions among heterosexuals. Conclusions. The model results support a continued focus on early diagnosis, treatment and adherence to ART, with an emphasis on prevention efforts for MSM, a subgroup of whom appear to play a role in transmission to heterosexuals.

[1]  S. Pinkerton.  How many sexually-acquired HIV infections in the USA are due to acute-phase HIV transmission? , 2007, AIDS.

[2]  A. Lansky,et al.  Human immunodeficiency virus (HIV) risk, prevention, and testing behaviors--United States, National HIV Behavioral Surveillance System: men who have sex with men, November 2003-April 2005. , 2006, Morbidity and mortality weekly report. Surveillance summaries.

[3]  R. Wiegand,et al.  Understanding disparities in HIV infection between black and white MSM in the United States , 2011, AIDS.

[4]  A. Lansky,et al.  Comparison of Demographic and Behavioral Characteristics of Men Who Have Sex With Men by Enrollment Venue Type in the National HIV Behavioral Surveillance System , 2012, Sexually transmitted diseases.

[5]  J. O. Wertheim,et al.  Using Molecular HIV Surveillance Data to Understand Transmission Between Subpopulations in the United States , 2015, Journal of acquired immune deficiency syndromes.

[6]  S. Pinkerton,et al.  The Bernoulli-Process Model of HIV Transmission , 1998 .

[7]  Irene A. Doherty,et al.  Concurrent sexual partnerships among men in the United States. , 2007, American journal of public health.

[8]  J. Skarbinski,et al.  Vital Signs: HIV Diagnosis, Care, and Treatment Among Persons Living with HIV — United States, 2011 , 2014, MMWR. Morbidity and mortality weekly report.

[9]  W. Mcfarland,et al.  HIV seroadaptation among individuals, within sexual dyads, and by sexual episodes, men who have sex with men, San Francisco, 2008 , 2011, AIDS care.

[10]  Ruiguang Song,et al.  Estimated HIV Incidence in the United States, 2006–2009 , 2011, PloS one.

[11]  Carlos Del Rio,et al.  The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. , 2011, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[12]  A. Chandra,et al.  Sexual behavior, sexual attraction, and sexual identity in the United States: data from the 2006-2008 National Survey of Family Growth. , 2011, National health statistics reports.

[13]  Michael Rayment,et al.  Prevention of HIV-1 infection with early antiretroviral therapy , 2012, Journal of Family Planning and Reproductive Health Care.

[14]  M. Cribbin,et al.  HIV risk, prevention, and testing behaviors among men who have sex with men--National HIV Behavioral Surveillance System, 21 U.S. cities, United States, 2008. , 2011, Morbidity and mortality weekly report. Surveillance summaries.

[15]  R. Ribeiro,et al.  Agent-based and phylogenetic analyses reveal how HIV-1 moves between risk groups: injecting drug users sustain the heterosexual epidemic in Latvia. , 2012, Epidemics.

[16]  S. Pinkerton.  HIV Transmission Rate Modeling: A Primer, Review, and Extension , 2012, AIDS and Behavior.

[17]  J. Fortenberry,et al.  Sexual behaviors, relationships, and perceived health status among adult women in the United States: results from a national probability sample. , 2010, The journal of sexual medicine.

[18]  Anne M Johnson,et al.  Time from human immunodeficiency virus seroconversion to reaching CD4+ cell count thresholds <200, <350, and <500 Cells/mm³: assessment of need following changes in treatment guidelines. , 2011, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[19]  J. Fortenberry,et al.  Sexual behavior in the United States: results from a national probability sample of men and women ages 14-94. , 2010, The journal of sexual medicine.

[20]  Brian Dodge,et al.  Sexual behaviors, relationships, and perceived health among adult men in the United States: results from a national probability sample. , 2010, The journal of sexual medicine.

[21]  J. Skarbinski,et al.  Behavioral and clinical characteristics of persons receiving medical care for HIV infection - Medical Monitoring Project, United States, 2009. , 2014, MMWR supplements.

[22]  J. Skarbinski,et al.  Human immunodeficiency virus transmission at each step of the care continuum in the United States. , 2015, JAMA internal medicine.

[23]  Patrick S Sullivan,et al.  Behavioral Surveillance among People at Risk for HIV Infection in the U.S.: The National HIV Behavioral Surveillance System , 2007, Public health reports.

[24]  Atlanta,et al.  Prevalence and awareness of HIV infection among men who have sex with men --- 21 cities, United States, 2008. , 2010, MMWR. Morbidity and mortality weekly report.

[25]  Michael Friend,et al.  Monitoring selected national HIV prevention and care objectives by using HIV surveillance data : United States and 6 dependent areas, 2015 , 2017 .

[26]  J. Fortenberry,et al.  Background and considerations on the National Survey of Sexual Health and Behavior (NSSHB) from the investigators. , 2010, The journal of sexual medicine.

[27]  Irene A. Doherty,et al.  Condom Use and Duration of Concurrent Partnerships Among Men in the United States , 2009, Sexually transmitted diseases.

[28]  M. Golden,et al.  Cost-Effectiveness of HIV Screening in STD Clinics, Emergency Departments, and Inpatient Units: A Model-Based Analysis , 2011, PloS one.

[29]  Christopher D Pilcher,et al.  Amplified transmission of HIV-1: comparison of HIV-1 concentrations in semen and blood during acute and chronic infection , 2007, AIDS.

[30]  J. Fortenberry,et al.  Condom use rates in a national probability sample of males and females ages 14 to 94 in the United States. , 2010, The journal of sexual medicine.

[31]  P. Rhodes,et al.  Undiagnosed HIV Prevalence Among Adults and Adolescents in the United States at the End of 2006 , 2009, Journal of acquired immune deficiency syndromes.

[32]  Christopher D Pilcher,et al.  Brief but efficient: acute HIV infection and the sexual transmission of HIV. , 2004, The Journal of infectious diseases.

[33]  Angela B. Hutchinson,et al.  Sexually acquired HIV infections in the United States due to acute-phase HIV transmission: an update. , 2009, AIDS.

[34]  HIV prevalence estimates--United States, 2006. , 2008, MMWR. Morbidity and mortality weekly report.

[35]  G. Marks,et al.  Prevalence and protective value of serosorting and strategic positioning among Black and Latino men who have sex with men. , 2010, Sexually transmitted diseases.

[36]  W. Mcfarland,et al.  Behavior, Intention or Chance? A Longitudinal Study of HIV Seroadaptive Behaviors, Abstinence and Condom Use , 2011, AIDS and Behavior.

[37]  Patrick S Sullivan,et al.  Number of casual male sexual partners and associated factors among men who have sex with men: Results from the National HIV Behavioral Surveillance system , 2011, BMC public health.