7th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013)


MOAC0201 - Oral Abstract

Early antiretroviral therapy, sexual behaviours and HIV-1 transmission risk: estimates from the Temprano-ANRS 12136 Randomized Controlled Trial, Abidjan, Côte d´Ivoire

Presented by Kévin Jean (France).

K. Jean1,2, D. Gabillard3,4, R. Moh3, C. Danel3, R. Fassassi5, A. Desgrées-du-Loû6, S. Eholié3,7, F. Lert1,2, X. Anglaret3,4, R. Dray-Spira1,2

1INSERM, Center for Research in Epidemiology and Population Health (CESP-U1018), Villejuif, France, 2Université Versaille Saint-Quentin, UMRS 1018, Villejuif, France, 3PAC-CI Program, CHU de Treichville, Abidjan, Cote D'Ivoire, 4Université Bordeaux Segalen, INSERM U897, Bordeaux, France, 5National Institute of Statistics and Applied Economy, Department of Population Research and Development, Abidjan, Cote D'Ivoire, 6IRD (Institut de Recherche pour le Développement), CEPED (Population and Development Research Center -UMR 196- Paris Descartes/INED/IRD), Paris, France, 7Service des Maladies Infectieuses et Tropicales, CHU de Treichville, Abidjan, Cote D'Ivoire

Background: Recent results demonstrated that early antiretroviral therapy (ART) reduced HIV-1 transmission by 96% among stable serodiscordant couples. However, a substantial part of new HIV infections worldwide occurs among non-stable relationships. We aimed to measure the impact of early ART on sexual behaviors and to estimate its protective effect among a population reporting mixed sexual partnerships.
Methods: We used data from an ongoing randomized controlled trial of early ART (Temprano-ANRS12136) in Abidjan. Participants were enrolled with CD4 counts above the WHO threshold for ART initiation and randomized to initiate ART either immediately (early ART) or according to WHO guidelines (standard ART). All participants included in Temprano between Jan. 2009 and Sept. 2011 were considered for the analysis. At 12-month visit (M12), information on last sexual intercourse in the past month was collected using standardized questionnaires. We compared proportions of risky sexual behaviors (unprotected sex with a partner of HIV negative/unknown status) and partner exposure to HIV infection (risky sexual behaviors plus detectable viral load [VL]) between participants with early vs. standard ART using Chi2 tests. HIV transmission risks in both groups were estimated based on reported sexual behaviors and VL-specific per-act HIV-1 transmission probabilities from the literature. Their ratio was computed to estimate the protective effect of early ART.
Results: A total of 957 participants were included (80.5% women, median[IQR] CD4/mm3: 478[396-582]). At M12, 46.0% of participants were sexually active in the past month, among whom 23.0% reported casual partnerships. Proportion of risky sexual behaviors was comparable in participants with early vs. standard ART (10.0 vs. 12.8%, p=0.17). However, because of VL difference (17.1 vs. 89.5% with VL≥300 copies/mm3), the proportion of participants exposing their partner to HIV infection was lower among those with early ART (2.4 vs. 10.7%, p< 0.001). Protective effect of early ART based on estimated HIV-transmission risks was 90% (95%CI: 81-95%).
Conclusion: In these West-African adults at early stages of HIV-infection and reporting mixed sexual partnerships, after 12 months of follow-up, early ART did not result in differences in sexual behaviors and decreased the risk of HIV-transmission by 90% compared to standard ART initiation.

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