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Trends in unsafe sex and influence of viral load among patients followed since primary HIV infection, 20002009

Seng, Rémoniea; Rolland, Matthieua; Beck-Wirth, Genevièveb; Souala, Faouzic; Deveau, Christianea; Delfraissy, Jean-Françoisd; Goujard, Cécilea,d; Meyer, Laurencea

doi: 10.1097/QAD.0b013e328345ef12
Epidemiology and Social

Background: In the current context of increasing unsafe sex, HIV incidence may have evolved, depending on HIV prevalence in sexual networks and, among HIV-infected persons who practice unsafe sex, on their infectivity and partners' HIV serostatus. We examined calendar trends in sexual behaviours at risk of HIV-1 transmission (SBR) among 967 adults followed since primary HIV infection (ANRS PRIMO cohort) and relationship with current treatments and viral load.

Methods: Patients completed since 2000 self-administered questionnaires on sexual practices every 6 months. SBR with HIV-negative/unknown partners were analyzed among 155 heterosexual women, 142 heterosexual men and 670 MSM by using logistic generalized estimating equation models (6656 visits).

Results: During 2000–2009, the frequency of SBR did not increase significantly among women with steady partners; risk factors were a low education level and alcohol/smoking use. Among heterosexual men with steady partners, the frequency of SBR doubled since 2006; during this period, the only associated factor was combined antiretroviral treatment for at least 6 months or viral load less than 400 copies/ml. Among MSM, SBR increased gradually over time; SBR with steady partners was associated with a low education level and alcohol use. SBR was more frequent among MSM with casual partners; no association with viral load was found.

Conclusion: In France, recent trends and risk factors in unprotected sex with HIV-negative/unknown partners differ according to sex/sexual preference. The recent increase in SBR among heterosexual men with low viral load may be related to increasing awareness of the ‘treatment-as-prevention’ concept. The lack of association between SBR and viral load among MSM supports use of treatment-as-prevention as part of diversified prevention strategies.

aCESP-INSERM U1018, University Paris Sud 11, Epidemiology Service, AP-HP, Bicêtre Hospital, Le Kremlin Bicêtre, France

bMulhouse Hospital, Mulhouse, France

cRennes Hospital, Rennes, France

dDepartment of Internal Medicine, Bicêtre Hospital, Le Kremlin Bicêtre, France.

Received 7 December, 2010

Revised 8 February, 2011

Accepted 18 February, 2011

Correspondence to Rémonie Seng, Service de Santé Publique, Hospital de Bicêtre, 82 rue du Général Leclerc, 94276 Le Kremlin-Bicêtre cedex, France. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.