Impact of early antiretroviral treatment on sexual behaviour: a randomised comparison.
Adult
Anti-Retroviral Agents
/ therapeutic use
CD4 Lymphocyte Count
Condoms
/ statistics & numerical data
Female
HIV Infections
/ drug therapy
Heterosexuality
/ psychology
Homosexuality, Male
/ psychology
Humans
Logistic Models
Male
Middle Aged
Risk-Taking
Sex Factors
Sexual Behavior
/ psychology
Sexual and Gender Minorities
/ statistics & numerical data
United States
Unsafe Sex
/ psychology
Journal
AIDS (London, England)
ISSN: 1473-5571
Titre abrégé: AIDS
Pays: England
ID NLM: 8710219
Informations de publication
Date de publication:
01 12 2019
01 12 2019
Historique:
entrez:
26
11
2019
pubmed:
26
11
2019
medline:
10
10
2020
Statut:
ppublish
Résumé
Antiretroviral treatment (ART) reduces HIV infectiousness but the effect of early ART on sexual behaviour is unclear. We assessed, within the START randomized trial that enrolled HIV-positive adults with CD4 cell count greater than 500 cells/μl, the effect of early (immediate) versus deferred ART on: condomless sex with HIV-serodifferent partners (CLS-D); all condomless sex (CLS); HIV transmission-risk sex (CLS-D-HIV risk, defined as CLS-D and: not on ART or started ART <6 months ago or viral load greater than 200 copies/ml or no viral load in past 6 months), during 2-year follow-up. Month-12 CLS-D (2010-2014) was the primary outcome. Among 2562 MSM, there was no difference between immediate and deferred arms in CLS-D at month 12 [12.6 versus 13.1%; difference (95% CI): -0.4% (-3.1 to 2.2%), P = 0.75] or month 24, or in CLS. Among 2010 heterosexual men and women, CLS-D at month 12 tended to be higher in the immediate versus deferred arm [10.8 versus 8.3%; difference:2.5% (-0.1 to 5.2%), P = 0.062]; the difference was greater at month 24 [9.3 versus 5.6%; difference: 3.7% (1.0 to 6.4%), P = 0.007], at which time CLS was higher in the immediate arm (20.7 versus 15.7%, P = 0.013). CLS-D-HIV risk at month 12 was substantially lower in the immediate versus deferred arm for MSM [0.2 versus 11%; difference: -10.7% (-12.5 to -8.9%), P < 0.001] and heterosexuals [0.6% versus 7.7%; difference: -7.0% (-8.8 to -5.3%), P < 0.001], because of viral suppression on ART. A strategy of early ART had no effect on condomless sex with HIV-serodifferent partners among MSM, but resulted in modestly higher prevalence among heterosexuals. However, among MSM and heterosexuals, early ART resulted in a substantial reduction in HIV-transmission-risk sex, to a very low absolute level.
Sections du résumé
BACKGROUND
Antiretroviral treatment (ART) reduces HIV infectiousness but the effect of early ART on sexual behaviour is unclear.
METHODS
We assessed, within the START randomized trial that enrolled HIV-positive adults with CD4 cell count greater than 500 cells/μl, the effect of early (immediate) versus deferred ART on: condomless sex with HIV-serodifferent partners (CLS-D); all condomless sex (CLS); HIV transmission-risk sex (CLS-D-HIV risk, defined as CLS-D and: not on ART or started ART <6 months ago or viral load greater than 200 copies/ml or no viral load in past 6 months), during 2-year follow-up. Month-12 CLS-D (2010-2014) was the primary outcome.
RESULTS
Among 2562 MSM, there was no difference between immediate and deferred arms in CLS-D at month 12 [12.6 versus 13.1%; difference (95% CI): -0.4% (-3.1 to 2.2%), P = 0.75] or month 24, or in CLS. Among 2010 heterosexual men and women, CLS-D at month 12 tended to be higher in the immediate versus deferred arm [10.8 versus 8.3%; difference:2.5% (-0.1 to 5.2%), P = 0.062]; the difference was greater at month 24 [9.3 versus 5.6%; difference: 3.7% (1.0 to 6.4%), P = 0.007], at which time CLS was higher in the immediate arm (20.7 versus 15.7%, P = 0.013). CLS-D-HIV risk at month 12 was substantially lower in the immediate versus deferred arm for MSM [0.2 versus 11%; difference: -10.7% (-12.5 to -8.9%), P < 0.001] and heterosexuals [0.6% versus 7.7%; difference: -7.0% (-8.8 to -5.3%), P < 0.001], because of viral suppression on ART.
CONCLUSION
A strategy of early ART had no effect on condomless sex with HIV-serodifferent partners among MSM, but resulted in modestly higher prevalence among heterosexuals. However, among MSM and heterosexuals, early ART resulted in a substantial reduction in HIV-transmission-risk sex, to a very low absolute level.
Identifiants
pubmed: 31764099
doi: 10.1097/QAD.0000000000002359
pii: 00002030-201912010-00007
pmc: PMC6882545
doi:
Substances chimiques
Anti-Retroviral Agents
0
Banques de données
ClinicalTrials.gov
['NCT00867048']
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2337-2350Subventions
Organisme : Medical Research Council
ID : MC_UU_12023/23
Pays : United Kingdom
Organisme : NIAID NIH HHS
ID : U01 AI136780
Pays : United States
Organisme : NIAID NIH HHS
ID : UM1 AI068641
Pays : United States
Organisme : NIAID NIH HHS
ID : UM1 AI120197
Pays : United States
Références
Lancet HIV. 2018 Aug;5(8):e438-e447
pubmed: 30025681
AIDS. 2011 Apr 24;25(7):977-88
pubmed: 21358375
Am J Public Health. 2004 Jul;94(7):1141-6
pubmed: 15226134
AIDS Care. 2010 Dec;22(12):1487-92
pubmed: 20845111
N Engl J Med. 2011 Aug 11;365(6):493-505
pubmed: 21767103
AIDS. 2012 Feb 20;26(4):489-95
pubmed: 22156971
JAMA. 2016 Jul 12;316(2):171-81
pubmed: 27404185
HIV Med. 2009 Aug;10(7):432-8
pubmed: 19459996
N Engl J Med. 2015 Aug 27;373(9):808-22
pubmed: 26193126
J Acquir Immune Defic Syndr. 2008 Oct 1;49(2):142-50
pubmed: 18769356
AIDS. 2009 Jul 17;23(11):1397-404
pubmed: 19381076
AIDS Behav. 2012 Aug;16(6):1708-15
pubmed: 21850443
Lancet HIV. 2017 Nov;4(11):e475
pubmed: 29096785
Sex Transm Infect. 2003 Feb;79(1):7-10
pubmed: 12576605
N Engl J Med. 2015 Aug 27;373(9):795-807
pubmed: 26192873
AIDS. 2004 Nov 5;18(16):2185-9
pubmed: 15577652
Lancet. 2019 Jun 15;393(10189):2428-2438
pubmed: 31056293
J Acquir Immune Defic Syndr. 2013 Jul 1;63(3):372-8
pubmed: 23422850
Clin Trials. 2013;10(1 Suppl):S5-S36
pubmed: 22547421
Arch Sex Behav. 2015 Feb;44(2):357-65
pubmed: 25318623
J Epidemiol Community Health. 2002 May;56(5):349-53
pubmed: 11964431
Lancet. 2010 Jun 12;375(9731):2092-8
pubmed: 20537376
BMC Public Health. 2014 Apr 17;14:379
pubmed: 24742202
AIDS. 2002 Nov 22;16(17):2329-33
pubmed: 12441806
AIDS. 2007 Jan;21 Suppl 1:S63-70
pubmed: 17159590
J Acquir Immune Defic Syndr. 2016 Aug 15;72(5):579-84
pubmed: 27070123
J Infect Dis. 2014 Feb 1;209(3):431-40
pubmed: 23990567
AIDS Care. 2013;25(9):1077-82
pubmed: 23336212
AIDS. 2014 May 15;28(8):1203-11
pubmed: 25000558
AIDS. 2018 Aug 24;32(13):1871-1879
pubmed: 29927787
AIDS. 2005 Jan 28;19(2):179-84
pubmed: 15668543
JAMA. 2004 Jul 14;292(2):224-36
pubmed: 15249572
Clin Infect Dis. 2010 Dec 1;51(11):1314-22
pubmed: 21034200
HIV Med. 2017 Aug;18(7):463-473
pubmed: 28004523
HIV Med. 2015 Apr;16 Suppl 1:64-76
pubmed: 25711325
J Acquir Immune Defic Syndr. 2002 Mar 1;29(3):275-83
pubmed: 11873077
Ann Behav Med. 2011 Aug;42(1):111-9
pubmed: 21494925
Sex Transm Infect. 2017 Dec;93(8):590-598
pubmed: 28679630
N Engl J Med. 2000 Mar 30;342(13):921-9
pubmed: 10738050
AIDS Behav. 2009 Dec;13(6):1129-42
pubmed: 19763810
Lancet. 2008 Jul 26;372(9635):314-20
pubmed: 18657710
AIDS Res Hum Retroviruses. 2001 Jul 1;17(10):901-10
pubmed: 11461676
AIDS. 2016 Jul 17;30(11):1745-59
pubmed: 27045375
AIDS Behav. 2007 Sep;11(5 Suppl):S6-16
pubmed: 17577655
AIDS. 2004 Aug 20;18(12):1707-14
pubmed: 15280782
Clin Infect Dis. 2014 Nov 15;59(10):1483-94
pubmed: 25091305