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Sexual behaviour among people with HIV according to self-reported antiretroviral treatment and viral load status

Lampe, Fiona C.; The Antiretrovirals, Sexual Transmission Risk and Attitudes (ASTRA) Study Group

doi: 10.1097/QAD.0000000000001104
Clinical Science

Objective: To assess, among people with HIV, the association of self-reported antiretroviral treatment (ART) and viral load status with condomless sex with an HIV-serodifferent partner (CLS-D).

Design: Cross-sectional study of 3258 HIV-diagnosed adults in the United Kingdom, 2011–2012.

Methods: CLS-D in the past 3 months and self-reported ART/viral load were ascertained by questionnaire. Clinic-recorded viral load was documented. HIV-transmission risk sex (CLS-D-HIV-risk) was defined as CLS-D together with either not on ART or clinic-recorded viral load more than 50 copies/ml.

Results: Of 3178 participants diagnosed more than 3 months ago, 2746 (87.9%) were on ART, of whom self-reported viral load was ‘50 copies/ml/ or less/undetectable’ for 78.4%; ‘more than 50 copies/ml/detectable’ for 8.3%; ‘do not know/missing’ for 13.3%. CLS-D prevalence was 14.9% (326/2189), 6.4% (23/360) and 10.7% (67/629) among men who have sex with men, heterosexual men and women, respectively. Among men who have sex with men, CLS-D prevalence was 18.8% among those not on ART; 15.2% among those on ART with undetectable self-reported viral load; 9.8% among those on ART without undetectable self-reported viral load. Compared with ‘on ART with undetectable self-reported viral load’, prevalence ratios (95% confidence interval) adjusted for demographic/HIV-related factors were: 0.66 (0.45, 0.95) for ‘on ART without undetectable self-reported viral load’, and 1.08 (0.78, 1.49) for ‘not on ART’ (global P = 0.021). Among heterosexual men and women (combined), ART/self-reported viral load was not associated with CLS-D [corresponding adjusted prevalence ratios: 1.14 (0.73, 1.79) for ‘on ART without undetectable self-reported viral load’; 0.88 (0.44, 1.77) for ‘not on ART’, P = 0.77]. CLS-D-HIV-risk prevalence was 3.2% among all participants; 16.1% for ‘not on ART’; 0.6% for ‘on ART with undetectable self-reported viral load; 4.2% for ‘on ART without undetectable self-reported viral load.’

Conclusion: Use of ART was not associated with increased prevalence of CLS-D, and was associated with greatly reduced prevalence of HIV-transmission risk sex.

Research Department of Infection and Population Health, University College London, London, UK.

Correspondence to Fiona C. Lampe, Research Department of Infection and Population Health, Royal Free Campus, University College London, London, UK. E-mail: f.lampe@ucl.ac.uk

* The members of the writing committee are mentioned at the end of the manuscript.

Received 30 November, 2015

Revised 13 March, 2016

Accepted 14 March, 2016

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