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Sexual risk behaviour relates to the virological and immunological improvements during highly active antiretroviral therapy in HIV-1 infection

Dukers, Nicole H. T. M.a; Goudsmit, Jaapb; de Wit, John B.; Prins, Mariaa; Weverling, Gerrit-Janc; Coutinho, Roel A.ab

Epidemiology & Social

Objectives: To evaluate the effect of highly active antiretroviral therapy (HAART) on the sexual behaviour of homosexual men, we conducted (i) an ecological study of time trends in sexual behaviour and sexually transmitted diseases; (ii) a HAART-effect study focused on the practice of unprotected anogenital sex.

Design: Subjects were participants in the ongoing Amsterdam Cohort Studies (ACS) among homosexual men, initiated in 1984. Data for (i) represented all ACS visits by HIV-1-positive and -negative participants who entered ACS at or below 30 years of age and were followed until 35 years (n = 1062). Data for (ii) represented all ACS visits of HIV-1-positive men from 1992 to 2000 (n = 365), of whom 84 were HAART recipients with at least 2 months of behavioural follow-up.

Results: (i) After HAART became generally available in July 1996, unprotected sex was practised more frequently and the incidence of gonorrhoea was higher compared to March 1992–June 1996 among HIV-1-negative and -positive men, respectively. (ii) Among HIV-1-positive men, a higher level of unprotected sex with casual partners was observed after HIV-1 RNA became undetectable and CD4 cell counts increased with the use of HAART. Notably, in individuals who did not receive HAART, high HIV-1-RNA levels (above 105 copies/ml) were likewise related to unprotected sex with casual partners.

Conclusion: Data support the need for the reinforcement of safe sex prevention messages among HIV-1-negative men, and our data also provide a lead for redirecting and tailoring current prevention strategies to the needs of HIV-1-positive men.

From the aDivision of Public Health and Environment, Municipal Health Service, Amsterdam, the Netherlands; bDepartment of Human Retrovirology, and cDepartment of Clinical Epidemiology and Biostatistics, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands; and dDepartment of Social and Organizational Psychology, University of Utrecht, Utrecht, the Netherlands.

Correspondence to: Nicole H.T.M. Dukers, MSc, Epidemiologist, Municipal Health Service Amsterdam, Division of Public Health and Environment, Nieuwe Achtergracht 100, PO Box 2200 1000 CE Amsterdam, the Netherlands. Tel: +31 20 5555524; fax: +31 20 5555533; e-mail:

Received: 11 August 2000;

revised: 6 November 2000; accepted: 23 November 2000.

Sponsorship: This study was supported by grants from the AIDS Fund (grant no. 1300), and performed as part of the Amsterdam Cohort Studies on HIV and AIDS (ACS), a collaboration between the Amsterdam Municipal Health Service, the Amsterdam Academic Medical Centre, the Central Laboratory of the Netherlands Red Cross Blood Transfusion Service, Amsterdam, and the Department of Social and Organizational Psychology, University of Utrecht, the Netherlands.

This paper was presented in part at the XIIIth International AIDS Conference, Durban, South Africa, 9–14 July 2000.

© 2001 Lippincott Williams & Wilkins, Inc.