Lars Jørgen Østergaard

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

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  • Alison J. Rodger, UCL
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  • Valentina Cambiano, UCL
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  • Andrew N. Phillips, UCL
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  • Tina Bruun, University of Copenhagen
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  • Dorthe Raben, University of Copenhagen
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  • Jens Lundgren, University of Copenhagen
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  • Pietro Vernazza, Department of Radiology and Nuclear Medicine Kantonsspital St. Gallen
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  • Simon Collins, HIV i-BASE
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  • Olaf Degen, University Medical Center Hamburg-Eppendorf
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  • Giulio Maria Corbelli, European AIDS Treatment Group
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  • Vicente Estrada, Hospital Clínico de San Carlos
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  • Anna Maria Geretti, University of Liverpool
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  • Apostolos Beloukas, University of Liverpool
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  • Apostolos Beloukas, University of West Attica
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  • Pep Coll, Hospital Universitari Germans Trias i Pujol
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  • Andrea Antinori, L. Spallanzani IRCCS
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  • Nneka Nwokolo, The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust
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  • Armin Rieger, Medical University of Vienna
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  • Jan M. Prins, University of Amsterdam
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  • Anders Blaxhult, Venhälsan
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  • Rainer Weber, University Hospital Zurich
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  • Arne Van Eeden, DC Klinieken
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  • Norbert H. Brockmeyer, Mineralogie und Geophysik
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  • Amanda Clarke, Brighton and Sussex University Hospitals NHS Trust
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  • Jorge del Romero Guerrero, Centro Sanitario Sandoval
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  • Francois Raffi, CHU Nantes
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  • Johannes R. Bogner, Klinikum Grosshaden
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  • Gilles Wandeler, University Hospital of Bern
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  • Jan Gerstoft, Rigshospitalet
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  • Felix Gutiérrez, Hospital General de Elche and Universidad Miguel Hernández
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  • Kees Brinkman, Onze Lieve Vrouwe Gasthuis (OLVG)
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  • Maria Kitchen, Medical University of Innsbruck
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  • Lars Ostergaard
  • Agathe Leon, Universitat Pompeu Fabra, Barcelona
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  • Matti Ristola, Helsinki University Central Hospital
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  • Heiko Jessen, Praxis Jessen + Kollegen
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  • Hans Jürgen Stellbrink, ICH Study Centre
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  • Andrew N Phillips, UCL, Denmark
  • Jens Lundgren, CHIP, Denmark
  • PARTNER Study Group

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 env sequences 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.

Original languageEnglish
JournalThe Lancet
Volume393
Issue10189
Pages (from-to)2428-2438
Number of pages11
ISSN0140-6736
DOIs
Publication statusPublished - Jun 2019

    Research areas

  • Adult, Anti-HIV Agents/therapeutic use, Antiretroviral Therapy, Highly Active, Condoms, HIV Seropositivity/transmission, Homosexuality, Male, Humans, Male, Middle Aged, Prospective Studies, Sexual Partners, Unsafe Sex, Viral Load

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