Impact of early antiretroviral treatment on sexual behaviour: a randomised comparison.

Autor:	Lampe FC; Institute for Global Health, University College London, London, UK., Rodger AJ; Institute for Global Health, University College London, London, UK., Burman W; Denver Public Health, University of Colorado Health Sciences Center, Denver, Colorado, USA., Grulich A; The Kirby Institute, University of New South Wales, Sydney, Australia., Friedland G; Departments of Medicine and Epidemiology, Yale School of Medicine, New Haven, Connecticut., Sadr WE; Columbia University, New York., Neaton J; University of Minnesota, Minnesota, USA., Corbelli GM; European AIDS Treatment Group, Bruxelles, Belgium., Emery S; The Kirby Institute, University of New South Wales, Sydney, Australia., Molina JM; Université de Paris, and Department of Infectious Diseases, Hopital Saint-Louis, Paris, France., Orkin C; Queen Mary University of London, London, UK., Gatell J; University of Barcelona and Viiv Healthcare, Barcelona, Spain., Gerstoft J; Copenhagen University Hospital, Copenhagen, Denmark., Ruxrungtham K; Chulalongkorn University, Bangkok, Thailand., Barbosa de Souza M; Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil., Phillips AN; Institute for Global Health, University College London, London, UK.
Jazyk:	angličtina
Zdroj:	AIDS (London, England) [AIDS] 2019 Dec 01; Vol. 33 (15), pp. 2337-2350.
DOI:	10.1097/QAD.0000000000002359
Abstrakt:	Background: Antiretroviral treatment (ART) reduces HIV infectiousness but the effect of early ART on sexual behaviour is unclear. Methods: We assessed, within the START randomized trial that enrolled HIV-positive adults with CD4 cell count greater than 500 cells/μl, the effect of early (immediate) versus deferred ART on: condomless sex with HIV-serodifferent partners (CLS-D); all condomless sex (CLS); HIV transmission-risk sex (CLS-D-HIV risk, defined as CLS-D and: not on ART or started ART <6 months ago or viral load greater than 200 copies/ml or no viral load in past 6 months), during 2-year follow-up. Month-12 CLS-D (2010-2014) was the primary outcome. Results: Among 2562 MSM, there was no difference between immediate and deferred arms in CLS-D at month 12 [12.6 versus 13.1%; difference (95% CI): -0.4% (-3.1 to 2.2%), P = 0.75] or month 24, or in CLS. Among 2010 heterosexual men and women, CLS-D at month 12 tended to be higher in the immediate versus deferred arm [10.8 versus 8.3%; difference:2.5% (-0.1 to 5.2%), P = 0.062]; the difference was greater at month 24 [9.3 versus 5.6%; difference: 3.7% (1.0 to 6.4%), P = 0.007], at which time CLS was higher in the immediate arm (20.7 versus 15.7%, P = 0.013). CLS-D-HIV risk at month 12 was substantially lower in the immediate versus deferred arm for MSM [0.2 versus 11%; difference: -10.7% (-12.5 to -8.9%), P < 0.001] and heterosexuals [0.6% versus 7.7%; difference: -7.0% (-8.8 to -5.3%), P < 0.001], because of viral suppression on ART. Conclusion: A strategy of early ART had no effect on condomless sex with HIV-serodifferent partners among MSM, but resulted in modestly higher prevalence among heterosexuals. However, among MSM and heterosexuals, early ART resulted in a substantial reduction in HIV-transmission-risk sex, to a very low absolute level.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu