Acute-Stage Transmission of HIV

Abstract

The role of acute-stage transmission in sustaining HIV epidemics has been difficult to determine. This difficulty is exacerbated by a lack of theoretical understanding of how partnership dynamics and sexual behavior interact to affect acute-stage transmission. We propose that individual-level variation in rates of sexual contact is a key aspect of partnership dynamics that can greatly increase acute-stage HIV transmission. Using an individual-based stochastic framework, we simulated a model of HIV transmission that includes individual-level changes in contact rates. We report both population-level statistics (such as prevalence and acute-stage transmission rates) and individual-level statistics (such as the contact rate at the time of infection). Volatility increases both the prevalence of HIV and the proportion of new cases from acute-stage infectors. These effects result from 1) a relative reduction in transmission rate from chronic but not acute infectors and 2) an increase in the availability of high-risk susceptibles. The extent of changes in individual-level contact rates in the real world is unknown. Aggregate or strictly cross-sectional data do not reveal individual-level changes in partnership dynamics and sexual behavior. The strong effects presented in this article motivate both continued theoretical exploration of volatility in sexual behavior and collection of longitudinal individual-level data to inform more realistic models.