Decrease in sexual risk behaviours after early initiation of antiretroviral therapy: a 24-month prospective study in Côte d'Ivoire

Kévin Jean, Delphine Gabillard, Raoul Moh, Christine Danel, Annabel Desgrées-du-Loû, Jean-Baptiste N'takpe, Jérôme Le Carrou, Anani Badjé, Serge Eholié, France Lert, Xavier Anglaret, Rosemary Dray-Spira, Kévin Jean, Delphine Gabillard, Raoul Moh, Christine Danel, Annabel Desgrées-du-Loû, Jean-Baptiste N'takpe, Jérôme Le Carrou, Anani Badjé, Serge Eholié, France Lert, Xavier Anglaret, Rosemary Dray-Spira

Abstract

Introduction: Whether early antiretroviral therapy (ART) initiation could impact sexual risk behaviours remains to be documented. We aimed to investigate changes in sexual behaviours within the 24 months following an early versus standard ART initiation in HIV-positive adults with high CD4 counts.

Methods: We used data from a prospective behavioural study nested in a randomized controlled trial of early ART (Temprano-ANRS12136). Time trends in sexual behaviours from enrolment in the trial (M0) to 12-month (M12) and 24-month (M24) visits were measured and compared, using Generalized Estimating Equations models, between participants randomly assigned either to initiate ART immediately (early ART) or to defer ART initiation until on-going WHO starting criteria are met (standard ART). Indicators of sexual behaviours included 1) sexual activity in the past year, 2) multiple partnership in the past year, 3) unprotected sex at last intercourse and 4) risky sex (i.e. unprotected sex with a partner of HIV negative/unknown status) at last intercourse.

Results: Analyses included 1952 participants (975 with early ART and 977 with standard ART; overall median baseline CD4 count: 469/mm(3)). Among participants with early ART, significant decreases were found between M0 and M24 in sexual activity (Odds Ratio [OR] 0.72, 95% Confidence Interval [95% CI] 0.57-0.92), multiple partnership (OR 0.57, 95% CI 0.41-0.79), unprotected sex (OR 0.59, 95% CI 0.47-0.75) and risky sex (OR 0.58, 95% CI 0.45-0.76). Among participants with standard ART, sexual behaviours showed similar trends over time. These decreases mostly occurred within the 12 months following enrolment in the trial in both groups and prior to ART initiation in participants with standard ART. For unprotected sex and risky sex, decreases were or tended to be more pronounced among patients reporting that their last sexual partner was non-cohabiting.

Conclusions: In these sub-Saharan adults with high CD4 counts, entry into HIV care, rather than ART initiation, resulted in decreased sexual activity and risky sexual behaviours. We did not observe any evidence of a risk compensation phenomenon associated with early ART initiation. These results illustrate the potential behavioural preventive effect of early entry into care, which goes hand in hand with early ART initiation.

Trial registration: ClinicalTrials.gov NCT00495651.

Keywords: AIDS; HIV; HIV prevention; antiretroviral treatment; early ART initiation; sexual behaviours; sub-Saharan Africa.

Figures

Figure 1
Figure 1
Sexual behaviours reported at inclusion (M0), 12-month visit (M12) and 24-month visit (M24) among participants of standard and early antiretroviral therapy (ART) groups. Socio-behavioural study nested in the Temprano Trial (N=1952). Patients in the standard ART group deferred ART initiation until on-going WHO starting criteria were met, whereas patients in the early ART group initiated ART immediately on inclusion in the trial. 1In the past year. 2At last intercourse in the past year. 3Defined as an unprotected intercourse with a partner of negative/unknown HIV status.

References

    1. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.
    1. Granich RM, Gilks CF, Dye C, De Cock KM, Williams BG. Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. Lancet. 2009;373(9657):48–57.
    1. Eaton JW, Johnson LF, Salomon JA, Bärnighausen T, Bendavid E, Bershteyn A, et al. HIV treatment as prevention: systematic comparison of mathematical models of the potential impact of antiretroviral therapy on HIV incidence in South Africa. PLoS Med. 2012;9(7):e1001245.
    1. Cassell MM, Halperin DT, Shelton JD, Stanton D. Risk compensation: the Achilles’ heel of innovations in HIV prevention? BMJ. 2006;332(7541):605–7.
    1. Eaton LA, Kalichman S. Risk compensation in HIV prevention: implications for vaccines, microbicides, and other biomedical HIV prevention technologies. Curr HIV/AIDS Rep. 2007;4(4):165–72.
    1. Dukers NH, Goudsmit J, de Wit JB, Prins M, Weverling GJ, Coutinho RA. Sexual risk behaviour relates to the virological and immunological improvements during highly active antiretroviral therapy in HIV-1 infection. AIDS. 2001;15(3):369–78.
    1. Tun W, Gange SJ, Vlahov D, Strathdee SA, Celentano DD. Increase in sexual risk behavior associated with immunologic response to highly active antiretroviral therapy among HIV-infected injection drug users. Clin Infect Dis. 2004;38(8):1167–74.
    1. Law MG, Prestage G, Grulich A, Van de Ven P, Kippax S. Modelling the effect of combination antiretroviral treatments on HIV incidence. AIDS. 2001;15(10):1287–94.
    1. Velasco-Hernandez JX, Gershengorn HB, Blower SM. Could widespread use of combination antiretroviral therapy eradicate HIV epidemics? Lancet Infect Dis. 2002;2(8):487–93.
    1. Wilson DP. HIV treatment as prevention: natural experiments highlight limits of antiretroviral treatment as HIV prevention. PLoS Med. 2012;9(7):e1001231.
    1. Venkatesh KK, Flanigan TP, Mayer KH. Is expanded HIV treatment preventing new infections? Impact of antiretroviral therapy on sexual risk behaviours in the developing world. AIDS. 2011;25(16):1939–49.
    1. Diabaté S, Alary M, Koffi CK. Short-term increase in unsafe sexual behaviour after initiation of HAART in Côte d'Ivoire. AIDS. 2008;22(1):154–6.
    1. WHO. Geneva: World Health Organisation; 2006. Antiretroviral therapy for HIV infection in adults and adolescents. Recommendations for a public health approach: 2006 revision.
    1. WHO. Geneva: World Health Organisation; 2010. Antiretroviral therapy for HIV infection in adults and adolescents. Recommendations for a public health approach: 2010 revision.
    1. Siegel K, Schrimshaw EW, Lekas H-M. Diminished sexual activity, interest, and feelings of attractiveness among HIV-infected women in two eras of the AIDS epidemic. Arch Sex Behav. 2006;35(4):437–49.
    1. Sarna A, Chersich M, Okal J, Luchters SMF, Mandaliya KN, Rutenberg N, et al. Changes in sexual risk taking with antiretroviral treatment: influence of context and gender norms in Mombasa, Kenya. Cult Health Sex. 2009;11(8):783–97.
    1. McGrath N, Richter L, Newell M-L. Sexual risk after HIV diagnosis: a comparison of pre-ART individuals with CD4 > 500 cells/(l and ART-eligible individuals in a HIV treatment and care programme in rural KwaZulu-Natal, South Africa. J Int AIDS Soc. 2013;16:18048.
    1. Adrien A, Leaune V, Dassa C, Perron M. Sexual behaviour, condom use and HIV risk situations in the general population of Quebec. Int J STD AIDS. 2001;12(2):108–15.
    1. Dunkle KL, Stephenson R, Karita E, Chomba E, Kayitenkore K, Vwalika C, et al. New heterosexually transmitted HIV infections in married or cohabiting couples in urban Zambia and Rwanda: an analysis of survey and clinical data. Lancet. 2008;371(9631):2183–91.
    1. Hargreaves JR, Morison LA, Kim JC, Busza J, Phetla G, Porter JDH, et al. Characteristics of sexual partnerships, not just of individuals, are associated with condom use and recent HIV infection in rural South Africa. AIDS Care. 2009;21(8):1058–70.
    1. Vu L, Andrinopoulos K, Mathews C, Chopra M, Kendall C, Eisele TP. Disclosure of HIV status to sex partners among HIV-infected men and women in Cape Town, South Africa. AIDS Behav. 2012;16(1):132–8.
    1. Moatti J-P, Prudhomme J, Traore DC, Juillet-Amari A, Akribi HA-D, Msellati P. Access to antiretroviral treatment and sexual behaviours of HIV-infected patients aware of their serostatus in Côte d'Ivoire. AIDS. 2003;3(17 Suppl):S69–77.
    1. Protopopescu C, Marcellin F, Préau M, Gabillard D, Moh R, Minga A, et al. Psychosocial correlates of inconsistent condom use among HIV-infected patients enrolled in a structured ART interruptions trial in Côte d'Ivoire: results from the TRIVACAN trial (ANRS 1269) Trop Med Int Health. 2010;15(6):706–12.
    1. Davies HTO, Crombie IK, Tavakoli M. When can odds ratios mislead? BMJ. 1998;316(7136):989–91.
    1. Guest G, Shattuck D, Johnson L, Akumatey B, Clarke EEK, Chen P-L, et al. Changes in sexual risk behavior among participants in a PrEP HIV prevention trial. Sex Transm Dis. 2008;35(12):1002–8.
    1. Abdool Karim Q, Abdool Karim SS, Frohlich JA, Grobler AC, Baxter C, Mansoor LE, et al. Effectiveness and safety of Tenofovir Gel, an antiretroviral microbicide, for the prevention of HIV infection in women. Science. 2010;329(5996):1168–74.
    1. Baeten JM, Donnell D, Ndase P, Mugo NR, Campbell JD, Wangisi J, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med. 2012;367(5):399–410.
    1. McGrath N, Eaton JW, Bärnighausen TW, Tanser F, Newell M-L. Sexual behaviour in a rural high HIV prevalence South African community: time trends in the antiretroviral treatment era. AIDS. 2013;27(15):2461–70.
    1. Kennedy C, O'Reilly K, Medley A, Sweat M. The impact of HIV treatment on risk behaviour in developing countries: a systematic review. AIDS Care. 2007;19(6):707–20.
    1. Berhan A, Berhan Y. Is the sexual behaviour of HIV patients on antiretroviral therapy safe or risky in Sub-Saharan Africa? Meta-analysis and meta-regression. AIDS Res Ther. 2012;9(1):14.
    1. Kaye DK, Kakaire O, Osinde MO, Lule JC, Kakande N. The impact of highly active antiretroviral therapy on high-risk behaviour of HIV-infected patients in sub-Saharan Africa. J Infect Dev Ctries. 2013;7(6):436–47.
    1. Rosen S, Fox MP. Retention in HIV care between testing and treatment in Sub-Saharan Africa: a systematic review. PLoS Med. 2011;8(7):e1001056.
    1. Sarna A, Luchters SMF, Geibel S, Kaai S, Munyao P, Shikely KS, et al. Sexual risk behaviour and HAART: a comparative study of HIV-infected persons on HAART and on preventive therapy in Kenya. Int J STD AIDS. 2008;19(2):85–9.
    1. Wandera B, Kamya MR, Castelnuovo B, Kiragga A, Kambugu A, Wanyama JN, et al. Sexual behaviours over a 3-year period among individuals with advanced HIV/AIDS receiving antiretroviral therapy in an urban HIV clinic in Kampala, Uganda. J Acquir Immune Defic Syndr. 2011;57(1):62–8.
    1. Weinhardt LS, Carey MP, Johnson BT, Bickham NL. Effects of HIV counseling and testing on sexual risk behavior: a meta-analytic review of published research, 1985–1997. Am J Public Health. 1999;89(9):1397–405.
    1. Fonner VA, Denison J, Kennedy CE, O'Reilly K, Sweat M. Voluntary counseling and testing (VCT) for changing HIV-related risk behavior in developing countries. Cochrane Database Syst Rev. 2012;9:CD001224.
    1. Ostrow DE, Fox KJ, Chmiel JS, Silvestre A, Visscher BR, Vanable PA, et al. Attitudes towards highly active antiretroviral therapy are associated with sexual risk taking among HIV-infected and uninfected homosexual men. AIDS. 2002;16(5):775–80.
    1. WHO. Geneva: World Health Organisation; 2012. Guidance on couples HIV testing and counseling including antiretroviral therapy for treatment as prevention in serodiscordant couples.
    1. Phillips AE, Gomez GB, Boily M-C, Garnett GP. A systematic review and meta-analysis of quantitative interviewing tools to investigate self-reported HIV and STI associated behaviours in low- and middle-income countries. Int J Epidemiol. 2010;39(6):1541–55.
    1. Jean K, Gabillard D, Moh R, Danel C, Fassassi R, Desgrees-du-Lou A, et al. Effect of early antiretroviral therapy on sexual behaviours and HIV-1 transmission risk in adults with diverse heterosexual partnership status in Côte d'Ivoire. J Infect Dis. 2014;209(3):431–40.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner