Journal article
Sexual Activity Without Condoms and Risk of HIV Transmission in Serodifferent Couples When the HIV-Positive Partner Is Using Suppressive Antiretroviral Therapy.
- Rodger AJ Research Department of Infection and Population Health, University College London, London, United Kingdom.
- Cambiano V Research Department of Infection and Population Health, University College London, London, United Kingdom.
- Bruun T Department of Infectious Diseases/CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
- Vernazza P Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital, St Gallen, Switzerland.
- Collins S HIV i-Base, London, United Kingdom.
- van Lunzen J University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany.
- Corbelli GM European AIDS Treatment Group, Bruxelles, Belgium.
- Estrada V Hospital Clinico San Carlos and Universidad Complutense, Madrid, Spain.
- Geretti AM Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.
- Beloukas A Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.
- Asboe D Chelsea and Westminster NHS Foundation Trust, London, United Kingdom.
- Viciana P Hospital Virgen del Rocío, Sevilla, Spain.
- Gutiérrez F Hospital General de Elche & Universidad Miguel Hernández, Alicante, Spain.
- Clotet B IrsiCaixa Foundation, UAB, UVIC-UCC, Hospital Universitari "Germans Trias i Pujol," Badalona, Catalonia, Spain.
- Pradier C Department of Public Health, Nice University Hospital and EA 6312, University Nice Sophia-Antipolis, France.
- Gerstoft J Rigshospitalet, Copenhagen, Denmark.
- Weber R Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
- Westling K Unit of Infectious Diseases and Dermatology, Department of Medicine, Karolinska Institutet, and Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
- Wandeler G Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.
- Prins JM Academic Medical Center, Amsterdam, the Netherlands.
- Rieger A Medical University of Vienna, Vienna, Austria.
- Stoeckle M Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
- Kümmerle T Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany.
- Bini T Ospedal San Paolo, Milan, Italy.
- Ammassari A Ospedale L. Spallanzani, Roma, Italy.
- Gilson R Research Department of Infection and Population Health, University College London, London, United Kingdom.
- Krznaric I Praxis Driesener Straße, Berlin, Germany.
- Ristola M Helsinki University Central Hospital, Helsinki, Finland.
- Zangerle R Medical University Innsbruck, Innsbruck, Austria.
- Handberg P Hvidovre Universitets Hospital, Hvidovre, Denamrk.
- Antela A Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.
- Allan S Coventry and Warwickshire Hospital, Coventry, United Kingdom.
- Phillips AN Research Department of Infection and Population Health, University College London, London, United Kingdom.
- Lundgren J Department of Infectious Diseases/CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
- 2016-07-13
Published in:
- JAMA. - 2016
Adult
Anti-HIV Agents
Condoms
Europe
Family Characteristics
Female
HIV Infections
HIV Seronegativity
HIV Seropositivity
HIV-1
Humans
Male
Middle Aged
Phylogeny
Prospective Studies
RNA, Viral
Risk
Sexual Behavior
Sexual Partners
Unsafe Sex
Viral Load
English
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.
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.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1001/jama.2016.5148
- PMID 27404185
- Persistent URL
- https://sonar.ch/global/documents/89842
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