Randomized, Controlled Pilot Study of Antiretrovirals and a Behavioral Intervention for Persons with Acute HIV Infection: Opportunity for Interrupting Transmission
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PhD,5 Dominic Nsona BA,4 Dana K. Pasquale PhD,2 Katherine B. Rucinski PhD,2 Jane S. Chen MPH,2 Carol E. Golin MD,6 Kimberly A. Powers PhD,2 Ann M. Dennis MD,3 Mina C. Hosseinipour MD, MPH,3 Joseph J. Eron MD,3 Wairimu Chege MD,7 Irving F. Hoffman MPH,3 Audrey E. Pettifor PhD2
Division of Epidemiology, The Ohio State University, Columbus, OH
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Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Lighthouse Trust, Lilongwe, Malawi
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UNC Project, Lilongwe, Malawi
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Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of
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Key points: Persons with acute HIV infection have heightened transmission risk. This randomized trial of
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behavioral and biomedical (ART) intervention demonstrates the feasibility of engaging acutely infected persons in HIV care and shows the potential for rapid decline in viral load after diagnosis of acute infection.
Key words: Acute HIV infection, HIV, motivational interviewing, Malawi, transmission
© The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons AttributionNonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact
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William C. Miller MD, PhD, MPH,1,2§ Sarah E. Rutstein MD, PhD,3 Sam Phiri MSc, PhD,4 Gift Kamanga
§ Correspondence:
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Alternate correspondence: Sarah E. Rutstein, MD, PhD The University of North Carolina at Chapel Hill Division of Infectious Diseases 101 Manning Drive Chapel Hill NC, 27514
[email protected]
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William C. Miller, MD, PhD, MPH The Ohio State University College of Public Health 302 Cunz Hall Columbus, OH 43210
[email protected] 614-292-2516
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Abstract Background: Persons with acute HIV infection (AHI) have heightened transmission risk. We evaluated potential transmission reduction using behavioral and biomedical interventions in a randomized Downloaded from https://academic.oup.com/ofid/advance-article-abstract/doi/10.1093/ofid/ofy341/5253671 by guest on 20 December 2018
controlled pilot study in Malawi.
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Methods: Persons were randomized 1:2:2 to standard counseling (SC), five-session behavioral intervention (BI), or behavioral intervention plus 12-weeks of antiretrovirals (ARVs; BIA). All were followed for 26-52 weeks; and, regardless of arm, referred for treatment according to Malawi-ARV guidelines. Participants were asked to refer partners for testing.
Results: Among 46 persons (9 SC, 18 BI, 19 BIA), average age was 28; 61% were male. Median viral load
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(VL) was 5.9 log copies/ml at enrollment: 67% (10/15) of BIA participants were suppressed (
