Increased HIV Suppression Needed in MSM Community

Mathematical models and prevention techniques assess viral suppression among HIV-positive men who have sex with men.

Reducing the amount of new HIV infections among men who have sex with men (MSM) is dependent on increasing the amount of HIV-positive MSM who have achieved viral suppression, a recent study found.

The key to sustained viral suppression is accessing and adhering to medication, according to a press release from the National Institutes of Health, which funded the study. The US Centers for Disease Control and Prevention reported that while MSM make up approximately 2% of the US population, they accounted for 67% of new cases of HIV in 2014.

Viral suppression among this population is quite low. In 2013, only 57% of MSM were receiving continuous care, and 58% achieved viral suppression. This means that many individuals could still transmit HIV to their partners.

Scientists created a novel mathematical model in the clinical study called HIV Prevention Trials Network (HPTN) 078, which assesses an HIV prevention technique. The prevention technique includes identifying HIV-positive MSM who are not virally suppressed, getting them into care, and helping them achieve and maintain suppression, according to the press release.

HPTN 078 is currently enrolling HIV-positive MSM living in Baltimore, Atlanta, Birmingham, and Boston, which are all cities that have a high HIV burden.

“Achieving and maintaining viral suppression is essential both for individual health and to reduce HIV transmission within the community,” said National Institute of Allergy and Infectious Diseases Director Anthony S. Fauci, MD. “Developing and validating strategies to enhance the engagement of men who have sex with men living with HIV in care and treatment is essential for controlling the HIV epidemic in this critical population in the United States.”

The new mathematical model was created to determine the increase in viral suppression needed to prevent new HIV infections among MSM living in Baltimore. In 2014, 30% of MSM in Baltimore were HIV-positive, and only 37% were virally suppressed.

The scientists found that the community would need to increase viral suppression by 10% within 5 years to reduce new infections by 20%, according to the press release. To reduce new infections by 20% over 10 years, viral suppression needs to increase by 8%.

The US National HIV/AIDS Strategy aims to have 90% of HIV-positive individuals to be diagnosed, 90% of those diagnosed receive antiretroviral treatments, and 90% of those treated achieve viral suppression by 2020. The mathematical model created in the HPTN 078 study suggests that to meet these targets, 75% of HIV-positive MSM need to achieve viral suppression, which would reduce HIV incidence by 50%.

HPTN 078 is planning on enrolling 2700 MSM who are at least 16-years-old. The scientists are aiming to determine the ability of peer-to-peer recruitment strategies to find MSM who are not virally suppressed, according to the press release.

Recruited individuals will reach out to other MSM, and the process will repeat. Since this population is difficult to reach out to, scientists hope that this recruitment strategy will be effective.

Enrolled individuals who are not virally suppressed will be randomized to a case management intervention or to standard care. Those assigned to case management will correspond with a trained case manager who will help the patient with healthcare and supportive services, as well as provide counseling for adherence to antiretroviral treatment, the National Institutes for Health reported.

These patients will also receive text messages, emails, and phone calls to remind them to take their medication and attend physician appointments. The scientists will determine which intervention was the most successful after 2 years.

In the future, the scientists will use mathematical models to predict the effects of case management and the level of viral suppression achieved with new HIV infections, according to the press release.

“Turning the tide on HIV will require a combination of evidence-based approaches,” said Dianne Rausch, PhD, director of the Division of AIDS Research at National Institutes of Mental Health. “We anticipate that the HPTN 078 study will provide important data to advance the evidence base on how to strengthen viral suppression in this community to save lives and prevent HIV infections.”