Academic journal article Alcohol Research

Biomedical Approaches to HIV Prevention

Academic journal article Alcohol Research

Biomedical Approaches to HIV Prevention

Article excerpt

People who use and abuse alcohol and other drugs are an important population to target for HIV prevention because they are more likely to engage in sexual behaviors that increase their likelihood of acquiring or transmitting HIV. A variety of biomedical approaches to HIV prevention have been evaluated or currently are being studied. These approaches include an anti-HIV vaccine; topical protection treatments; and additional biomedical and barrier approaches, such as controlling sexually transmitted diseases, male circumcision, diaphragm use, and substance abuse treatment. The article also reviews topical versus oral antiretrovirals to prevent HIV transmission, antiretroviral treatment as prevention, and the role of alcohol and other drug use in HIV prevention. KEY WORDS: Alcohol and other drug use, abuse, and dependence; human immunodeficiency virus (HIV); HIV prevention; risk factors; sexual behavior; treatment

Approximately 80 percent of the more than 60 million people infected with the human us (HIV) since the epidemic was first detected more than 25 years ago were infected via sexual intercourse (The United Nations Joint Programme on HIV/AIDS [UNAIDS] 2007). Ironically, this mode of transmission is not particularly efficient. Early studies estimated the rate of HIV sexual transmission to be less than 1 per 2,000 for coital acts with an infected partner (Royce et al. 1997). Certain sexual practices are more efficient in facilitating HIV transmission than others. For example, receptive anal intercourse may have an efficiency as high as 1 per 10, although other studies have found it to be as inefficient as 1 per 6,000 (Shattock and Moore 2003). The high variability in the estimates of the efficiency of HIV transmission stems from two factors. First, because it would be unethical to observe HIV transmission in real time, studies of transmission are based on interviews with newly infected people. These studies may collect data over several months, during which multiple risky exposures could occur. Second, there is substantial biological variability in factors that facilitate infectiousness and susceptibility. For example, anything that increases the level of HIV concentration in blood will be associated with the efficiency of sexual transmission. Therefore, people who are acutely infected with HIV, who experience increased plasma viremia, or those who have advanced HIV disease would be more likely to transmit to their partners (Wawer et al. 2005). Other factors associated with increased transmission rates include concomitant and genital tract infections; other causes of local inflammation, stage of infection (acute, early, latent, or late); concurrent sexually transmitted diseases (STD) and coinfections; vaccines, which can increase viral load; and pregnancy (Chan and Ray 2007; Cohn 2004; Gray et al. 2005; Modjarrad et al. 2008; Ostrowski et al. 1997). The most prominent factor associated with decreased likelihood of becoming infected is male circumcision because the male foreskin contains many cells that can bind HIV (Bailey et al. 2007; Gray et al. 2007). Genetic factors which may alter the cellular receptors which can bind HIV, rendering some hosts less susceptible to HIV, and other genetic loci may make some people more capable of mounting an effective response to initial HIV infection (Rowland-Jones et al. 2001).

It also is feasible that medication to inhibit HIV (i.e., antiretroviral therapy) may decrease the likelihood of an infected person transmitting HIV to his or her partner (Cohen et al. 2002). Unfortunately, despite the increased access to antiretroviral therapy, there are more than 2.5 million new HIV infections occurring across the globe (UNAIDS 2007). Some feel that increased access to antiretroviral therapy (Granich et al. 2009), or even providing antiretroviral therapy only to symptomatic individuals (Wagner and Blower 2009), might be able to drastically curb the rates of new infections. Others note, however, that before antiretroviral therapy can have an appreciable impact on the epidemic, all patients taking the medication would need to be fully adherent and have suppressed viral loads all the time; have optimal management for genital-tract inflammation, like sexually transmitted infections (STIs); and have to not increase risk-taking behavior on the belief that they may be less infectious. …

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