Acute HIV infection - A key link for transmission prevention

急性艾滋病毒感染——预防传播的关键环节

基本信息

批准号：
7898740
负责人：
WILLIAM C MILLER
金额：
$ 103.63万
依托单位：
UNIV OF NORTH CAROLINA CHAPEL HILL
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-08-01 至 2013-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7898740
关键词：
AIDS prevention Acute Address Africa South of the Sahara Anti-Retroviral Agents Antigens Behavior Therapy Behavioral Biological Blood Clinic Communities Complement Counseling Coupled Data Detection Diagnosis Epidemic Epidemiology Evaluation Event HIV HIV Infections Individual Infection Intervention Lamivudine Link Malawi Modeling Motivation Network-based Participant Persons Pharmaceutical Preparations Phase Pilot Projects Play Prevention Prevention program Probability RNA Randomized Relative (related person)Research Infrastructure Role Sex Behavior Sexual Partners Sexually Transmitted Diseases Site Staging Structure Technology Tenofovir Testing Time Unsafe Sex Viral Load result Virus Work antiretroviral therapy base community planning design genital secretion mathematical model models and simulation new technology novel novel strategies prevent programs randomized trial rapid diagnosis skills transmission process

项目摘要

DESCRIPTION (provided by applicant): Persons with acute HIV infection (AHI) may be responsible for a substantial proportion of onward transmission of HIV infection, especially in sub-Saharan Africa. AHI, the period between infection and seroconversion, lasts up to 10-12 weeks. During this brief window of time, the virus replicates rapidly, leading to high concentrations of HIV RNA in blood and genital secretions. Consequently, the probability of transmission during unprotected intercourse is very high. Identifying persons with AHI and intervening to reduce onward transmission represents a tantalizing, but unproven, opportunity for HIV prevention. We propose an aggressive HIV transmission prevention program to identify persons with AHI and intervene behaviorally and biologically. Our central hypothesis is that persons with acute HIV infection play an important role in HIV transmission. We further hypothesize that behavioral and treatment interventions in acutely infected persons will reduce onward transmission. To address these hypotheses, we will conduct an exploratory study complemented by mathematical modeling to assess the potential impact of the proposed prevention program. The specific aims of our proposed study are to: 1) Develop a novel program to prevent HIV transmission by identifying and informing persons with acute HIV infection (AHI) in Lilongwe, Malawi, 2) Evaluate a short-term, combined behavioral and antiretroviral therapy (ART) intervention to prevent HIV transmission among persons with AHI, 3) Determine the potential individual and combined impact of each component of the intervention using mathematical modeling. To achieve these aims, we will use our well-established infrastructure in Lilongwe, Malawi. We will take advantage of new and existing technologies to identify people with AHI more rapidly. Immediately after diagnosis, persons will be randomized to standard counseling, an intensive behavioral intervention, or the behavioral intervention combined with short term antiretroviral therapy (ART). The behavioral intervention is based on the Information-Motivation- Behavioral Skills Model. The ART will use new and potent antiretroviral drugs to rapidly block HIV replication and limit infectiousness. Using the data collected in this pilot study, we will use rigorous mathematical modeling to assess the potential impact of the prevention program on the epidemic within a community and plan a large randomized trial. Persons with acute HIV infection (AHI), the earliest stage of HIV infection, may transmit HIV infection at a high rate, especially in sub-Saharan Africa. Given this important possibility, we hypothesize that behavioral and treatment interventions in acutely infected persons will reduce their transmission. To address this hypothesis, we will conduct an exploratory study, coupled with mathematical modeling, to examine the potential impact of combining a behavioral intervention with a course of antiretroviral treatment in persons with AHI.

描述（由申请人提供）：急性艾滋病毒感染者 (AHI) 可能是艾滋病毒感染继续传播的主要原因，特别是在撒哈拉以南非洲地区。 AHI，即感染和血清转化之间的时期，持续长达 10-12 周。在这段短暂的时间内，病毒复制迅速，导致血液和生殖器分泌物中 HIV RNA 浓度很高。因此，在无保护的性交过程中传播的可能性非常高。识别 AHI 患者并进行干预以减少进一步传播是预防艾滋病毒的一个诱人但未经证实的机会。我们提出了一项积极的艾滋病毒传播预防计划，以识别 AHI 患者并进行行为和生物学干预。我们的中心假设是，急性艾滋病毒感染者在艾滋病毒传播中发挥着重要作用。我们进一步假设对急性感染者的行为和治疗干预将减少进一步传播。为了解决这些假设，我们将进行一项探索性研究，并辅以数学模型，以评估拟议预防计划的潜在影响。我们提出的研究的具体目标是：1) 通过识别和告知马拉维利隆圭的急性艾滋病毒感染者 (AHI) 来预防艾滋病毒传播，2) 评估短期行为和抗逆转录病毒治疗相结合的治疗(ART) 预防 AHI 患者中艾滋病毒传播的干预措施，3) 使用数学模型确定干预措施每个组成部分的潜在个体和综合影响。为了实现这些目标，我们将利用我们在马拉维利隆圭完善的基础设施。我们将利用新技术和现有技术更快地识别 AHI 患者。诊断后，患者将立即被随机分配接受标准咨询、强化行为干预或行为干预与短期抗逆转录病毒治疗 (ART) 相结合。行为干预基于信息-动机-行为技能模型。 ART 将使用新型有效的抗逆转录病毒药物来快速阻止 HIV 复制并限制传染性。利用本试点研究中收集的数据，我们将使用严格的数学模型来评估预防计划对社区内流行病的潜在影响，并计划进行大型随机试验。患有急性艾滋病毒感染（AHI）（艾滋病毒感染的最早阶段）的人可能会以很高的速度传播艾滋病毒感染，特别是在撒哈拉以南非洲地区。鉴于这种重要的可能性，我们假设对急性感染者的行为和治疗干预将减少其传播。为了解决这一假设，我们将进行一项探索性研究，并结合数学模型，以检验行为干预与抗逆转录病毒治疗疗程相结合对 AHI 患者的潜在影响。