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Behavioral changes following HIV seroconversion during the historical expansion of HIV treatment in the United States

Zhu, Wenjiaa; Bazzi, Samuel A.b; Bazzi, Angela R.c

doi: 10.1097/QAD.0000000000002048

Objectives: To identify the ways in which HIV seroconversion impacts subsequent health behaviors in the context of evolving HIV treatment technologies.

Design: Prospective cohort study.

Methods: We assessed changes in health and HIV risk behaviors following HIV seroconversion both before and after HIV treatment access (i.e. HAART) in the United States by drawing from the Multicenter AIDS Cohort Study, which collected data from men who have sex with men (MSM) (n = 4616) in four US cities from 1984 to 2008. Longitudinal regression analyses with individual fixed effects accounted for time-invariant, unobservable determinants of risk behaviors. Further analyses assessed the sensitivity of our results to controlling for indicators of physical and mental health (e.g. CD4+ cell count, depression) and differential attrition by higher risk individuals.

Results: Among those who seroconverted during observation (n = 558), HIV seroconversion was associated with reduced odds of subsequent engagement in sex with at least two partners [adjusted odds ratio [adjusted odds ratio (aOR): 0.371; confidence interval (CI): 0.263–0.523], insertive anal sex with at least two partners (aOR: 0.360; CI: 0.219–0.591), and heavy drinking (aOR: 0.704; CI: 0.508–0.977). Seroconversion after HAART availability and treatment initiation was associated with further reduced odds of engaging in these behaviors. CD4+ cell count, depression, and attrition did not change these results.

Conclusion: Specific health and HIV risk behaviors declined following seroconversion, especially with treatment availability and utilization. These positive behavior changes following HIV seroconversion provide evidence for continued investment in the HIV care continuum, including support for HIV testing and engagement in clinical care and treatment.

aDepartment of Health Care Policy, Harvard Medical School

bDepartment of Economics, Boston University

cDepartment of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA.

Correspondence to Angela R. Bazzi, PhD, MPH, Assistant Professor, Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Rm 442E, Boston, MA 02118, USA. Tel: +1 617 414 1355; fax: +1 617 638 4483; e-mail:

Received 9 May, 2018

Accepted 14 September, 2018

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