The Association Between Prosocial Behavior and Mental Health: A Three-Level Meta-Analysis.

While antiretroviral therapy (ART) has proven to successfully improve the life expectancy of people living with HIV, the search for a cure is ongoing. The current obstacle to curing HIV is its persistence in the body as a reservoir of latently infected CD4+ T cells. These reservoir cells can be activated following cessation of ART, leading to viral rebound [,]. However, recent research suggests that post-treatment control is possible for some people living with HIV following analytical treatment interruption (ATI) [,]. An ATI study is defined as temporary cessation of ART under thorough clinical and laboratory care []. The nature of these studies guide HIV cure research, seek to identify ART-free viral control mechanisms, and explore how effective new treatment strategies and interventions are []. They also help in characterizing how immune mechanism may be involved in achieving and maintaining viral suppression post-intervention []. Since the rollout of ART in Botswana in the early 2000s, public health messaging has emphasized lifelong ART without interruption. This messaging is based on the expected 70+ year persistence of the latent reservoir in adults [] and increased risk of drug resistance if ART is non-continuous [,]. ATI studies are crucial to perform to identify individuals who may no longer require ART, and are now considered to be safe with close monitoring for viral rebound. Selected people living with HIV who may be able to stop ART in the setting of an ATI study include: (1) those who may have been misdiagnosed in early life, when false positive testing may be more frequent []; (2) those who initially tested positive but no longer show evidence for intact (replication-competent) HIV in their reservoirs; and (3) those who have very low viral reservoirs or locked viral reservoirs (HIV integrated mostly in non-encoding regions of the genome) and can control any small amount of HIV replication with their own immune system [,]. Before enrolment in ATI studies, it is essential to understand the different perceptions of people living with HIV, caregivers of people living with HIV and stakeholders in ATI-inclusive studies. Previous work has reported ATI perceptions in high-burden regions and indicated that young people living with HIV expressed concerns regarding risks during blood draws, mental health issues and potential coercion to participate in ATI studies []. However, in the same study, young people living with HIV highlighted that engaging in clinical research will give them better access to care and HIV education []. How acceptable ATI studies will be in Botswana is currently unknown. It is also not known how to prevent misperceptions, including therapeutic misconceptions, whereby participants may interpret experimental remission outcomes as indications of a definitive HIV cure []. These misperceptions may lead to individuals to stop ART on their own outside of the research context. Furthermore, while data from the region suggest that young populations can tolerate the psychological uncertainty of ATI, success is heavily dependent on addressing anxieties regarding viral rebound and potential transmission to partners []. For caregivers, the decision-making process is further complicated by the burden of increased clinical monitoring and fears of treatment failure [].