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NEW THIS FRIDAY: EFFECT OF EARLY A.R.T. ON SEXUAL BEHAVIORS AND HIV-1 TRANSMISSION RISK, IVORY COAST

Wednesday, 25th of September 2013

• EFFECT OF EARLY A.R.T. ON SEXUAL BEHAVIORS AND HIV-1 TRANSMISSION RISK, IVORY COAST

Journal of Infectious Diseasesjid.oxfordjournals.org

J Infect Dis. (2013) doi: 10.1093/infdis/jit470 First published online: August 29, 2013

Effect of Early Antiretroviral Therapy on Sexual Behaviors and HIV-1 Transmission Risk Among Adults With Diverse Heterosexual Partnership Statuses in Côte dIvoire

Kévin Jean1,2,  et al.

+ Author Affiliations

1Epidemiology of Occupational and Social Determinants of Health, Center for Research in Epidemiology and Population Health, INSERM U1018

2UMRS 1018, Université Versailles Saint-Quentin, Villejuif

3INSERM U897, Université Bordeaux Segalen, Bordeaux

4CEPED, UMR 196, Paris Descartes/INED/IRD, IRD, Paris, France

5PAC-CI Program, CHU de Treichville

6Department of Population Research and Development, National Institute of Statistics and Applied Economy

7Service des Maladies Infectieuses et Tropicales, CHU de Treichville, Abidjan, Côte dIvoire, France

Correspondance: Kévin Jean, MSc, CESP Eq. 11, Hôp. Paul Brousse, Bât 15-16, 16 avenue Paul Vaillant Couturier, 94800 Villejuif, France (kevin.jean@inserm.fr).

Presented in part: 7th IAS Conference on HIV Pathogenesis, Treatment, and Prevention, Kuala Lumpur, Malaysia, 30 June–3 July 2013. Abstract MOAC0201.

Abstract below; full text is at http://jid.oxfordjournals.org/content/early/2013/09/24/infdis.jit470.full

Background. The effect of early initiation of antiretroviral therapy (ART; ie, at CD4+ T-cell counts >350 cells/mm3) on sexual behaviors and human immunodeficiency virus type 1 (HIV) transmission risk has not been documented in populations other than HIV-serodiscordant couples in stable relationships.

Methods. On the basis of data from a behavioral study nested in a randomized, controlled trial (Temprano-ANRS12136) of early ART, we compared proportions of risky sex (ie, unprotected sex with a partner of negative/unknown HIV status) reported 12 months after inclusion between participants randomly assigned to initiate ART immediately (hereafter, “early ART”) or according to ongoing World Health Organization criteria. Group-specific HIV transmission rates were estimated on the basis of sexual behaviors and viral load–specific per-act HIV transmission probabilities. The ratio of transmission rates was computed to estimate the protective effect of early ART.

Results. Among 957 participants (baseline median CD4+ T-cell count, 478 cells/mm3), 46.0% reported sexual activity in the past month; of these 46.0%, sexual activity for 41.5% involved noncohabiting partners. The proportion of subjects who engaged in risky sex was 10.0% in the early ART group, compared with 12.8% in the standard ART group (P = .17). After accounting for sexual behaviors and viral load, we estimated that the protective effect of early ART was 90% (95% confidence interval, 81%–95%).

Conclusion. Twelve months after inclusion, patients in the early and standard ART groups reported similar sexual behaviors. Early ART decreased the estimated risk of HIV transmission by 90%, suggesting a major prevention benefit among seronegative sex partners in stable or casual relationships with seropositive individuals.