Sexual Activity Without Condoms and Risk of HIV Transmission in Serodifferent Couples When the HIV-Positive Partner Is Using Suppressive Antiretroviral Therapy

Bibliographic Data

ID23385396
AuthorsAlec Rodger (0000-0001-8817-4651, University College London), Alison J Rodger (Research Department of Infection and Population Health, University College London, London, United Kingdom), Valentina Cambiano (0000-0003-0700-105X, Research Department of Infection and Population Health, University College London, London, United Kingdom), Tina Bruun (Department of Infectious Diseases/CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark), Pietro Vernazza (0000-0002-6849-6941, Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital, St Gallen, Switzerland), Simon Collins (0000-0002-1984-927X, HIV i-Base, London, United Kingdom), Jan van Lunzen (University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany), Giulio Maria Corbelli (0000-0001-5246-7161, European AIDS Treatment Group, Bruxelles, Belgium), Vicente Estrada (0000-0002-7795-5986, Hospital Clinico San Carlos and Universidad Complutense, Madrid, Spain), Anna Maria Geretti (0000-0002-3670-6588, University of Liverpool), Apostolos Beloukas (0000-0001-5639-0528, University of Liverpool), David Asboe (0000-0001-6857-7920, Chelsea and Westminster NHS Foundation Trust, London, United Kingdom), Pompeyo Viciana (Hospital Virgen del Rocío, Sevilla, Spain), Félix Gutiérrez (0000-0002-9485-6867, Hospital General de Elche & Universidad Miguel Hernández, Alicante, Spain), Bonaventura Clotet (0000-0003-3232-4598, IrsiCaixa Foundation, UAB, UVIC-UCC, Hospital Universitari “Germans Trias i Pujol,” Badalona, Catalonia, Spain), Christian Pradier (0000-0002-0676-6379, Department of Public Health, Nice University Hospital and EA 6312, University Nice Sophia-Antipolis, France), Jan Gerstoft (0000-0002-1054-9748, Rigshospitalet, Copenhagen, Denmark), Rainer Weber (0000-0001-6100-0416, Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland), Katarina Westling (0000-0002-8755-1037, Unit of Infectious Diseases and Dermatology, Department of Medicine, Karolinska Institutet, and Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden), Gilles Wandeler (0000-0002-5278-8763, Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland), Jan M Prins (0000-0002-5415-8933, Academic Medical Center, Amsterdam, the Netherlands), Armin Rieger (0000-0003-0340-0117, Medical University of Vienna, Vienna, Austria), Marcel Stoeckle (0000-0002-0088-5078, Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland), Tim Kümmerle (Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany), Teresa Bini (Ospedal San Paolo, Milan, Italy), Adriana Ammassari (0000-0002-0284-0340, Ospedale L. Spallanzani, Roma, Italy), Richard Gilson (0000-0002-9572-193X, Research Department of Infection and Population Health, University College London, London, United Kingdom), Ivanka Krznaric (0000-0001-9672-9661, Praxis Driesener Straße, Berlin, Germany), Matti Ristola (0000-0001-5115-2811, Helsinki University Central Hospital, Helsinki, Finland), Robert Zangerle (0000-0002-5375-7299, Medical University Innsbruck, Innsbruck, Austria), Pia Handberg (Hvidovre Universitets Hospital, Hvidovre, Denamrk), Antonio Antela (0000-0002-4819-0953, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain), Sris Allan (0000-0001-8666-4817, Coventry and Warwickshire Hospital, Coventry, United Kingdom), Andrew N Phillips (0000-0003-2384-4807, Research Department of Infection and Population Health, University College London, London, United Kingdom), Jens Lundgren (0000-0001-8901-7850, Department of Infectious Diseases/CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark)
Year2016
Volume316
Issue2
Pages171
Publication date2016-07-12
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueJAMA (JOURNAL)
Journal identifiersISSN: 0098-7484 • E-ISSN: 1538-3598
PublisherAmerican Medical Association (AMA) (PUBLISHER)
DOI10.1001/jama.2016.5148
PMID27404185
OpenAlexW2461009619
LanguageEN
Citations received261
References cited6

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.

Antiretroviral therapy · Human immunodeficiency virus (HIV) · Microbicide · Sexual transmission · Transmission (telecommunications) · Viral load · Adolescent Sexual and Reproductive Health · HIV Research and Treatment · HIV/AIDS Research and Interventions · Medicine · Virology

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