XIX International AIDS Conference


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MOPDC0106 - Poster Discussion Session

Sustained treatment as prevention: continued decreases in unprotected sex and increases in virological suppression after HAART initiation among participants in HPTN 052

Presented by Kenneth Mayer (United States).

K. Mayer1, L. Wang2, I. Hoffman3, M. McCauley4, X. Li2, S. Safren5, T. Gamble4, J. Talley4, L. Cottle6, E. Piwowar-Manning7, V. Akelo8, S. Badal-Faesen9, N. Chotirosniramit10, N.M. Fernandes11, N. Kumarasamy12, S. Sahay13, J. Makhema14, B. Panchia15, J.H.d.S. Pilotto16, B.R. Santos17, M.S. Cohen18

1Fenway Community Health, Boston, United States, 2Fred Hutchinson Cancer Research Center, Vaccine and Infectious Disease Division, Seattle, United States, 3University of North Carolina - Chapel Hill, Department of Medicine, Chapel Hill, United States, 4FHI 360, Washington, United States, 5Harvard Medical School/Massachusetts General Hospital and Fenway Health, Boston, United States, 6Statistical Center for HIV/AIDS Research & Prevention (SCHARP), Seattle, United States, 7Johns Hopkins University School of Medicine, Pathology Department, Baltimore, United States, 8Kenya Medical Research Institute Center for Global Health Research, Kisumu, Kenya, 9University of the Witwatersrand, Clinical HIV Research Unit, Johannesburg, South Africa, 10Chiang Mai University, Research Institute for Health Sciences, Chiang Mai, Thailand, 11Instituto de Pesquisa Clinica Evandro Chagas, Rio de Janeiro, Brazil, 12YRG CARE Medical Centre, VHS, Chennai, India, 13National AIDS Research Institute (ICMR), Pune, India, 14Botswana Harvard AIDS Institute, Gabarone, Botswana, 15University of the Witwatersrand, Perinatal HIV Research Unit, Johannesburg, South Africa, 16Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz, Rio de Janeiro, Brazil, 17Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil, 18University of North Carolina School of Medicine, Department of Medicine, Chapel Hill, United States

Background: HPTN 052 demonstrated a 96% decrease in HIV transmission when infected persons in serodiscordant relationships initiated HAART at study entry compared to those randomized to delayed treatment. However, this benefit could be attenuated if HIV-infected participants subsequently increased unprotected sex without virological control.
Methods: Between 06/2007 and 05/2010, 1763 HIV serodiscordant couples were enrolled in 9 countries in Africa, Asia and the Americas, and followed for a median of 2 years. The current analyses compared the sexual behavior of HIV-infected participants before and after they initiated HAART, and examined trends to evaluate whether risk taking changed over time by GEE models.
Results: At enrollment, 4.0% of HIV-infected participants in the early treatment group (E) and 5.7% in the delayed arm (D) self-reported unprotected vaginal intercourse (UVI) with their primary partner within the past week. At 3 months, 2.9% of E participants did, compared to 3.0% of D participants (p=0.9). Over 2 years, UVI decreased among all participants (β=-0.015, p=0.04), and the time trend was similar in both arms. Participants engaging in UVI were more likely to be female (AOR=1.6, 95%CI 1.1-2.4), from South America vs. Asia, AOR=16.0, 95%CI 8.2-31.3), from Africa vs. Asia(AOR=8.8, 95%CI 5.0-15.6), use substances (AOR=2.2,95% CI 1.3-3.9), and have a lower viral load at enrollment (AOR=0.7, 95% CI 0.6-0.9). After 2 years, 91% of E participants were virologically suppressed, compared with 22% of D participants. Self-reported unprotected anal intercourse was uncommon (< 0.3% at baseline, and no change over time).Only 21% of participants on HAART who engaged in UVI or UAI had detectable plasma viremia.
Conclusions: Participants randomized to early HAART and those who subsequently initiated HAART did not increase risk taking over several years. The decrease in sexual risk taking, coupled with effective virologic suppression, suggest that earlier initiation of HAART could have sustained effects in decreasing HIV transmission.

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