This Week in HIV Research: Effect of Viral Load Perception on Sex, and HIV Prevention Options Needed in U.S. Prisons

This week, a study finds that viral load perception may change sexual behaviors among HIV-positive men who have sex with men (MSM). Another study finds that U.S. prisons urgently need more HIV prevention interventions. And women living with HIV who are not on antiretroviral therapy are more likely to transmit HIV to their infants if they have cytomegalovirus. To beat HIV, you have to follow the science!

Perceived Undetectable Viral Load May Change Sexual Behavior

MSM living with HIV may be more likely to engage in sexual practices that carry a risk of HIV transmission if they believe their viral load (VL) to be undetectable, a small study in San Francisco, Calif., showed. The research was published in the Journal of Acquired Immune Deficiency Syndromes.

Fewer than 100 men replied to the survey, and 68 of them agreed to laboratory testing. Nine of the 68 said they had a detectable VL. Testing confirmed participants' self-perceived VL in more than 90% of cases. Close to 3% of those who reported an undetectable VL in fact had a detectable VL. Such an "inaccurate perception of undetectable status poses the greatest risk of HIV transmission," researchers noted. However, the study data were collected before pre-exposure prophylaxis had become popular in the city.

The small sample size precluded statistically significant conclusions and study authors called for further research into the influence of viral load perception on sexual risk behavior.

HIV Prevention in U.S. Prisons "Urgently Needed"

A systematic review of HIV prevention studies in U.S. prisons that was published in AIDS Care identified "an urgent need to continue to implement HIV prevention interventions across all prisons." The 27 studies included in the review focused on U.S. adult prison populations before release.

The most effective interventions are peer-led and actively involve participants, concluded some of the studies surveyed. Other results were: women need help with communication skills to enable them to negotiate safer sex practices; and non-consensual sex poses a special problem for women and lesbian, gay, bisexual or transgender (LGBT) people.

The review also identified gaps in study data: racial disparities between African Americans, whites and Latinos were reported, but no data were available on Asians/Pacific Islanders, Alaskan Natives or American Indians. The impact of transactional sex on HIV transmission in prison likewise had not been studied. Study authors called for further research to to improve prevention opportunities.

Cytomegalovirus Increases Risk of Mother-to-Child Transmission of HIV, if Mothers Are Not Taking Antiretrovirals

Women living with HIV who are shedding cytomegalovirus (CMV) in their urinary tract are significantly more likely to transmit both HIV and CMV to their infants, a study published in Clinical Infectious Diseases found.

Participants were not on antiretroviral treatment during pregnancy, and study authors caution that these results should not be extrapolated to women who are on antiretrovirals prior to giving birth. Researchers analyzed urine from 260 women in South Africa and the Americas. The babies of women with CMV in their urine at the time of labor and delivery were five times more likely to have HIV and 30 times more likely to have CMV than the newborns of women without CMV.

Study authors hypothesized that local CMV reactivation due to pregnancy- and HIV-related immunosuppression may be the cause of these results. CMV itself may also contribute to the higher transmission rate of both viruses. Another risk factor for transmission of CMV was the mother's infection with gonorrhea. Results reinforce the need of HIV treatment during pregnancy, study authors concluded.