Rodger, Alison J., Cambiano, Valentina, Bruun, Tina, Vernazza, Pietro, Collins, Simon, van Lunzen, Jan, Corbelli, Giulio Maria, Estrada, Vicente ORCID: 0000-0002-7795-5986, Geretti, Anna Maria, Beloukas, Apostolos ORCID: 0000-0001-5639-0528, Asboe, David, Viciana, Pompeyo, Gutierrez, Felix, Clotet, Bonaventura, Pradier, Christian, Gerstoft, Jan, Weber, Rainer, Westling, Katarina, Wandeler, Gilles, Prins, Janm M., Rieger, Armin, Stoeckle, Marcel, Kuemmerle, Tim, Bini, Teresa, Ammassari, Adriana ORCID: 0000-0002-0284-0340, Gilson, Richard, Krznaric, Ivanka, Ristola, Matti ORCID: 0000-0001-5115-2811, Zangerle, Robert, Handberg, Pia, Antela, Antonio, Allan, Sris, Phillips, Andrew N. and Lundgren, Jens (2016). Sexual Activity Without Condoms and Risk of HIV Transmission in Serodifferent Couples When the HIV-Positive Partner Is Using Suppressive Antiretroviral Therapy. JAMA-J. Am. Med. Assoc., 316 (2). S. 171 - 182. CHICAGO: AMER MEDICAL ASSOC. ISSN 1538-3598

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Abstract

IMPORTANCE A key factor in assessing the effectiveness and cost-effectiveness of antiretroviral therapy (ART) as a prevention strategy is the absolute risk of HIV transmission through condomless sex with suppressed HIV-1 RNA viral load for both anal and vaginal sex. OBJECTIVE To evaluate the rate of within-couple HIV transmission (heterosexual and men who have sex with men [MSM]) during periods of sex without condoms and when the HIV-positive partner had HIV-1 RNA load less than 200 copies/mL. DESIGN, SETTING, AND PARTICIPANTS The prospective, observational PARTNER (Partners of People on ART-A New Evaluation of the Risks) study was conducted at 75 clinical sites in 14 European countries and enrolled 1166 HIV serodifferent couples (HIV-positive partner taking suppressive ART) who reported condomless sex (September 2010 to May 2014). Eligibility criteria for inclusion of couple-years of follow-up were condomless sex and HIV-1 RNA load less than 200 copies/mL. Anonymized phylogenetic analysis compared couples' HIV-1 polymerase and envelope sequences if an HIV-negative partner became infected to determine phylogenetically linked transmissions. EXPOSURES Condomless sexual activity with an HIV-positive partner taking virally suppressive ART. MAIN OUTCOMES AND MEASURES Risk of within-couple HIV transmission to the HIV-negative partner RESULTS Among 1166 enrolled couples, 888 (mean age, 42 years [IQR, 35-48]; 548 heterosexual [61.7%] and 340 MSM [38.3%]) provided 1238 eligible couple-years of follow-up (median follow-up, 1.3 years [IQR, 0.8-2.0]). At baseline, couples reported condomless sex for a median of 2 years (IQR, 0.5-6.3). Condomless sex with other partners was reported by 108 HIV-negative MSM (33%) and 21 heterosexuals (4%). During follow-up, couples reported condomless sex a median of 37 times per year (IQR, 15-71), with MSM couples reporting approximately 22 000 condomless sex acts and heterosexuals approximately 36 000. Although 11 HIV-negative partners became HIV-positive (10 MSM; 1 heterosexual; 8 reported condomless sex with other partners), no phylogenetically linked transmissions occurred over eligible couple-years of follow-up, giving a rate of within-couple HIV transmission of zero, with an upper 95% confidence limit of 0.30/100 couple-years of follow-up. The upper 95% confidence limit for condomless anal sex was 0.71 per 100 couple-years of follow-up. CONCLUSIONS AND RELEVANCE Among serodifferent heterosexual and MSM couples in which the HIV-positive partner was using suppressive ART and who reported condomless sex, during median follow-up of 1.3 years per couple, there were no documented cases of within-couple HIV transmission (upper 95% confidence limit, 0.30/100 couple-years of follow-up). Additional longer-term follow-up is necessary to provide more precise estimates of risk.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Rodger, Alison J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Cambiano, ValentinaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bruun, TinaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Vernazza, PietroUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Collins, SimonUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
van Lunzen, JanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Corbelli, Giulio MariaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Estrada, VicenteUNSPECIFIEDorcid.org/0000-0002-7795-5986UNSPECIFIED
Geretti, Anna MariaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Beloukas, ApostolosUNSPECIFIEDorcid.org/0000-0001-5639-0528UNSPECIFIED
Asboe, DavidUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Viciana, PompeyoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gutierrez, FelixUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Clotet, BonaventuraUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pradier, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gerstoft, JanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Weber, RainerUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Westling, KatarinaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wandeler, GillesUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Prins, Janm M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rieger, ArminUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Stoeckle, MarcelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kuemmerle, TimUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bini, TeresaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ammassari, AdrianaUNSPECIFIEDorcid.org/0000-0002-0284-0340UNSPECIFIED
Gilson, RichardUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Krznaric, IvankaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ristola, MattiUNSPECIFIEDorcid.org/0000-0001-5115-2811UNSPECIFIED
Zangerle, RobertUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Handberg, PiaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Antela, AntonioUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Allan, SrisUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Phillips, Andrew N.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lundgren, JensUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-269938
DOI: 10.1001/jama.2016.5148
Journal or Publication Title: JAMA-J. Am. Med. Assoc.
Volume: 316
Number: 2
Page Range: S. 171 - 182
Date: 2016
Publisher: AMER MEDICAL ASSOC
Place of Publication: CHICAGO
ISSN: 1538-3598
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
HOMOSEXUAL-MEN; HETEROSEXUAL TRANSMISSION; ANAL INTERCOURSE; VIRAL LOAD; PREVENTION; ERAMultiple languages
Medicine, General & InternalMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/26993

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