Lars Jørgen Østergaard

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

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

DOI

  • Alison J Rodger, Research Department of Infection and Population Health, University College London, London, United Kingdom.
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  • Valentina Cambiano, Research Department of Infection and Population Health, University College London, London, United Kingdom.
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  • Tina Bruun, University of Copenhagen
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  • Pietro Vernazza, Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital, St Gallen, Switzerland.
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  • Simon Collins, HIV i-Base, London, United Kingdom.
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  • Jan van Lunzen, Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; University Cancer Center Hamburg, University (UCCH), University Medical Center Hamburg-Eppendorf, Germany.
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  • Giulio Maria Corbelli, European AIDS Treatment Group, Bruxelles, Belgium.
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  • Vicente Estrada, Hospital Clinico San Carlos and Universidad Complutense, Madrid, Spain.
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  • Anna Maria Geretti, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.
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  • Apostolos Beloukas, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.
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  • David Asboe, Chelsea and Westminster NHS Foundation Trust, London, United Kingdom.
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  • Pompeyo Viciana, Hospital Virgen del Rocío, Sevilla, Spain.
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  • Félix Gutiérrez, Hospital General de Elche & Universidad Miguel Hernández, Alicante, Spain.
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  • Bonaventura Clotet, IrsiCaixa Foundation, UAB, UVIC-UCC, Hospital Universitari "Germans Trias i Pujol," Badalona, Catalonia, Spain.
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  • Christian Pradier, Department of Public Health, Nice University Hospital and EA 6312, University Nice Sophia-Antipolis, France.
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  • Jan Gerstoft, Rigshospitalet, Copenhagen, Denmark.
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  • Rainer Weber, Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
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  • Katarina Westling, Unit of Infectious Diseases and Dermatology, Department of Medicine, Karolinska Institutet, and Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
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  • Gilles Wandeler, Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.
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  • Jan M Prins, Department of Clinical Genetics, Academic Medical Center, Amsterdam, The Netherlands.
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  • Armin Rieger, Medical University of Vienna, Vienna, Austria
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  • Marcel Stoeckle, Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
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  • Tim Kümmerle, Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany.
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  • Teresa Bini, Ospedal San Paolo, Milan, Italy.
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  • Adriana Ammassari, Ospedale L. Spallanzani, Roma, Italy.
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  • Richard Gilson, Research Department of Infection and Population Health, University College London, London, United Kingdom.
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  • Ivanka Krznaric, Praxis Driesener Straße, Berlin, Germany.
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  • Matti Ristola, Helsinki University Central Hospital, Helsinki, Finland.
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  • Robert Zangerle, Department of Psychiatry and Psychotherapy, Innsbruck Medical University, Innsbruck, Austria
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  • Pia Handberg, Hvidovre Universitets Hospital, Hvidovre, Denamrk.
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  • Antonio Antela, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.
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  • Sris Allan, Coventry and Warwickshire Hospital, Coventry, United Kingdom.
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  • Andrew N Phillips, Research Department of Infection and Population Health, University College London, London, United Kingdom.
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  • Jens Lundgren, Department of Infectious Diseases/CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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  • PARTNER Study Group (Lars Østergaard, member)

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.

Original languageEnglish
JournalJAMA: The Journal of the American Medical Association
Volume316
Issue2
Pages (from-to)171-81
Number of pages11
ISSN0098-7484
DOIs
Publication statusPublished - 12 Jul 2016

    Research areas

  • 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, Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't

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