#Risk of #HIV #transmission through condomless sex in serodifferent gay couples with the #HIV-positive partner taking suppressive #antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study (Lancet, abstract)

[Source: The Lancet, full page: (LINK). Abstract, edited.]

Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study

Prof Alison J Rodger, FRCP, Valentina Cambiano, PhD, Tina Bruun, RN, Prof Pietro Vernazza, MD, Simon Collins, Olaf Degen, MD, Giulio Maria Corbelli, BSc, Vicente Estrada, MD, Prof Anna Maria Geretti, FRCPath, Apostolos Beloukas, PhD, Dorthe Raben, PhD, Pep Coll, MD, Andrea Antinori, MD, Nneka Nwokolo, MBBS, Armin Rieger, MD, Prof Jan M Prins, PhD, Anders Blaxhult, MD, Prof Rainer Weber, MD, Arne Van Eeden, MD, Prof Norbert H Brockmeyer, MD, Amanda Clarke, MD, Jorge del Romero Guerrero, MD, Prof Francois Raffi, PhD, Prof Johannes R Bogner, MD, Gilles Wandeler, MD, Prof Jan Gerstoft, MD, Prof Felix Gutiérrez, PhD, Prof Kees Brinkman, PhD, Maria Kitchen, MD, Prof Lars Ostergaard, MedScD, Agathe Leon, PhD, Matti Ristola, PhD, Heiko Jessen, MD, Prof Hans-Jürgen Stellbrink, MedScD, Prof Andrew N Phillips, PhD, Prof Jens Lundgren, PhD, for thePARTNER Study Group †

Open Access / Published: May 02, 2019 / DOI: https://doi.org/10.1016/S0140-6736(19)30418-0

 

Summary

Background

The level of evidence for HIV transmission risk through condomless sex in serodifferent gay couples with the HIV-positive partner taking virally suppressive antiretroviral therapy (ART) is limited compared with the evidence available for transmission risk in heterosexual couples. The aim of the second phase of the PARTNER study (PARTNER2) was to provide precise estimates of transmission risk in gay serodifferent partnerships.

Methods

The PARTNER study was a prospective observational study done at 75 sites in 14 European countries. The first phase of the study (PARTNER1; Sept 15, 2010, to May 31, 2014) recruited and followed up both heterosexual and gay serodifferent couples (HIV-positive partner taking suppressive ART) who reported condomless sex, whereas the PARTNER2 extension (to April 30, 2018) recruited and followed up gay couples only. At study visits, data collection included sexual behaviour questionnaires, HIV testing (HIV-negative partner), and HIV-1 viral load testing (HIV-positive partner). If a seroconversion occurred in the HIV-negative partner, anonymised phylogenetic analysis was done to compare HIV-1 pol and envsequences in both partners to identify linked transmissions. Couple-years of follow-up were eligible for inclusion if condomless sex was reported, use of pre-exposure prophylaxis or post-exposure prophylaxis was not reported by the HIV-negative partner, and the HIV-positive partner was virally suppressed (plasma HIV-1 RNA <200 copies per mL) at the most recent visit (within the past year). Incidence rate of HIV transmission was calculated as the number of phylogenetically linked HIV infections that occurred during eligible couple-years of follow-up divided by eligible couple-years of follow-up. Two-sided 95% CIs for the incidence rate of transmission were calculated using exact Poisson methods.

Findings

Between Sept 15, 2010, and July 31, 2017, 972 gay couples were enrolled, of which 782 provided 1593 eligible couple-years of follow-up with a median follow-up of 2·0 years (IQR 1·1–3·5). At baseline, median age for HIV-positive partners was 40 years (IQR 33–46) and couples reported condomless sex for a median of 1·0 years (IQR 0·4–2·9). During eligible couple-years of follow-up, couples reported condomless anal sex a total of 76 088 times. 288 (37%) of 777 HIV-negative men reported condomless sex with other partners. 15 new HIV infections occurred during eligible couple-years of follow-up, but none were phylogenetically linked within-couple transmissions, resulting in an HIV transmission rate of zero (upper 95% CI 0·23 per 100 couple-years of follow-up).

Interpretation

Our results provide a similar level of evidence on viral suppression and HIV transmission risk for gay men to that previously generated for heterosexual couples and suggest that the risk of HIV transmission in gay couples through condomless sex when HIV viral load is suppressed is effectively zero. Our findings support the message of the U=U (undetectable equals untransmittable) campaign, and the benefits of early testing and treatment for HIV.

Funding

National Institute for Health Research.

Keywords: HIV/AIDS; Antivirals; STI.

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gimi69

I am an Italian blogger, active since 2005 with main focus on emerging infectious diseases such as avian influenza, SARS, antibiotics resistance, and many other global Health issues. Other fields of interest are: climate change, global warming, geological and biological sciences. My activity consists mainly in collection and analysis of news, public services updates, confronting sources and making decision about what are the 'signals' of an impending crisis (an outbreak, for example). When a signal is detected, I follow traces during the entire course of an event. I started in 2005 my blog ''A TIME'S MEMORY'', now with more than 40,000 posts and 3 millions of web interactions. Subsequently I added an Italian Language blog, then discontinued because of very low traffic and interest. I contributed for seven years to a public forum (FluTrackers.com) in the midst of the Ebola epidemic in West Africa in 2014, I left the site to continue alone my data tracking job.

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