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Statistical Communications in Infectious Diseases

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Mathematical Citation Quotient 2013: 0.08

Episodic HIV Risk Behavior Can Greatly Amplify HIV Prevalence and the Fraction of Transmissions from Acute HIV Infection

Xinyu Zhang1 / Lin Zhong2 / Ethan Romero-Severson3 / Shah Jamal Alam4 / Christopher J. Henry5 / Erik M. Volz6 / 7

1University of Michigan - Ann Arbor

2University of Michigan - Ann Arbor

3University of Michigan - Ann Arbor

4University of Michigan - Ann Arbor

5University of Michigan - Ann Arbor

6University of Michigan - Ann Arbor

7University of Michigan - Ann Arbor

Citation Information: Statistical Communications in Infectious Diseases. Volume 4, Issue 1, ISSN (Online) 1948-4690, DOI: 10.1515/1948-4690.1041, November 2012

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A deterministic compartmental model was explored that relaxed the unrealistic assumption in most HIV transmission models that behaviors of individuals are constant over time. A simple model was formulated to better explain the effects observed. Individuals had a high and a low contact rate and went back and forth between them. This episodic risk behavior interacted with the short period of high transmissibility during acute HIV infection to cause dramatic increases in prevalence as the differences between high and low contact rates increased and as the duration of high risk better matched the duration of acute HIV infection. These same changes caused a considerable increase in the fraction of all transmissions that occurred during acute infection. These strong changes occurred despite a constant total number of contacts and a constant total transmission potential from acute infection. Two phenomena played a strong role in generating these effects. First, people were infected more often during their high contact rate phase and they remained with high contact rates during the highly contagious acute infection stage. Second, when individuals with previously low contact rates moved into an episodic high-risk period, they were more likely to be susceptible and thus provided more high contact rate susceptible individuals who could get infected. These phenomena make test and treat control strategies less effective and could cause some behavioral interventions to increase transmission. Signature effects on genetic patterns between HIV strains could make it possible to determine whether these episodic risk effects are acting in a population.

Keywords: HIV; mathematical modeling; risk behavior; MSM

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