Abstract
IntroductionPeople living with HIV (PLHIV) on antiretroviral therapy (ART), with sustained undetectable viral load (sUVL) and no history of sexually transmitted infections for at least six months, are considered to have a low risk of HIV transmission (LRT). We aimed to characterize, in a representative sample of French PLHIV, the sexual behaviour of LRT PLHIV compared with non-LRT PLHIV.MethodsThe cross-sectional ANRS-VESPA2 survey was conducted on adult PLHIV attending French hospitals in 2011. The LRT PLHIV group included participants with sUVL and no sexually transmitted infection for at least 12 months. Socio-behavioural and medical data were collected. Chi-square tests helped compare sexual risk indicators between LRT and non-LRT PLHIV. The survey's retrospective nature allowed us to perform complementary category-based analyses of LRT PLHIV according to whether they had sUVL for at least 18, 24 or 36 months in three socio-epidemiological groups: men who have sex with men (MSM), other men and women.ResultsAnalysis included 2638 PLHIV diagnosed >12 months with available viral load data. The proportion of LRT PLHIV varied from 58% (≥12 months sUVL) to 38% (≥36 months sUVL). Irrespective of sUVL duration, we found the following: 1) LRT men (MSM and other men) were more likely to report having no sexual partner than their non-LRT counterparts. Among men having sexual partners in the previous 12 months, no significant difference was seen between LRT and non-LRT men in the number of sexual partners. LRT women were less likely to report having more than one sexual partner than non-LRT women; 2) LRT MSM were more likely to report being in sexually inactive couples than their non-LRT counterparts; 3) among sexually active participants, no difference was observed between LRT and non-LRT PLHIV concerning condom use with their serodiscordant steady partner or with their most recent casual sexual partners.ConclusionsLRT PLHIV with sUVL ≥12 months did not report more sexual risk behaviours than their non-LRT counterparts. Because the same result was obtained for those having a sUVL ≥36 months, the hypothesis of increased sexual risk behaviour over time in PLHIV meeting non-transmission biomedical criteria is not supported.
Highlights
People living with HIV (PLHIV) on antiretroviral therapy (ART), with sustained undetectable viral load and no history of sexually transmitted infections for at least six months, are considered to have a low risk of HIV transmission (LRT)
Meta-analysis by Crepaz et al demonstrated no higher rates of condomless sex between people living with HIV (PLHIV) on Antiretroviral therapies (ART) with a detectable viral load (VL) and with undetectable VL (UVL)
There was a high prevalence of condomless sex in persons Á with known or unknown HIV status Á who believed that being on ART or having an UVL protects against HIV transmission or who were less concerned about engaging in unsafe sex because of ART availability
Summary
People living with HIV (PLHIV) on antiretroviral therapy (ART), with sustained undetectable viral load (sUVL) and no history of sexually transmitted infections for at least six months, are considered to have a low risk of HIV transmission (LRT). Because the same result was obtained for those having a sUVL ]36 months, the hypothesis of increased sexual risk behaviour over time in PLHIV meeting non-transmission biomedical criteria is not supported. In 2008, the Swiss Federal Commission for HIV/AIDS stated that HIV-positive heterosexual individuals on effective ART Á individuals having an undetectable plasma VL for at least six months with no sexually transmitted infection (STI) during the same period Á can be considered sexually non-infectious [5] This statement has led to considerable debate about possible sexual risk disinhibition or risk compensation in this population [6Á10], offsetting the benefits of current biomedical HIV prevention strategies. We used data collected during the ANRS-VESPA2 survey to analyze, for the first time, the evolution over time of sexual risk behaviour in three distinct socio-epidemiological groups: MSM, women and other men, according to the biomedical criterion of HIV transmission risk
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