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Heterosexual risk of HIV transmission per sexual act under combined antiretroviral therapy: systematic review and bayesian modeling.

ABSTRACT: BACKGROUND: Although essential for patient counseling and quality of life of human immunodeficiency virus (HIV)-infected individuals, the risk of HIV transmission during 1 unprotected sex act with an HIV-infected person under combination antiretroviral therapy (cART) remains unknown. METHODS: We reviewed systematically the literature for studies on HIV transmission among heterosexual HIV-serodiscordant couples, where the infected partner was on cART, with regular virological monitoring, reporting on condom use and sexual activity. We used Bayesian statistics to combine data from selected studies, to investigate the per-act risk of HIV transmission through unprotected sex with an HIV-infected person on cART for >6 months. RESULTS: At most, 1 HIV transmission, over an estimated 113 480 sex acts, of which 17% were not condom protected, was reported within 1672 HIV-serodiscordant couples where the index partner had been treated for >6 months. Data were insufficient to determine whether the reported transmission occurred before or after 6 months of cART. We estimated the upper-bound per-act risk of HIV transmission at either 8.7 or 13:100 000, depending on whether the transmission occurred before or after 6 months of cART. These estimates applied whether or not index partners were virally suppressed. Estimating an upper-bound risk <1:100 000 would require observing no HIV transmission while collecting >12 times the available amount of data. CONCLUSIONS: Available data do not support zero risk of HIV transmission under cART. The per-act risk of HIV transmission through unprotected sex with HIV-infected individuals on cART in comprehensive care for >6 months (whether or not virally suppressed) is <13:100 000. Estimating a 10-fold lower upper-bound risk may be unfeasible due to high condom use among HIV-serodiscordant couples in most research studies.

SUBMITTER: Supervie V

PROVIDER: S-EPMC4305135 | biostudies-literature | 2014 Jul

REPOSITORIES: biostudies-literature

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Heterosexual risk of HIV transmission per sexual act under combined antiretroviral therapy: systematic review and bayesian modeling.

Supervie Virginie V Viard Jean-Paul JP Costagliola Dominique D Breban Romulus R

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 20140409 1

<h4>Background</h4>Although essential for patient counseling and quality of life of human immunodeficiency virus (HIV)-infected individuals, the risk of HIV transmission during 1 unprotected sex act with an HIV-infected person under combination antiretroviral therapy (cART) remains unknown.<h4>Methods</h4>We reviewed systematically the literature for studies on HIV transmission among heterosexual HIV-serodiscordant couples, where the infected partner was on cART, with regular virological monitor ...[more]

PMID: 24723286

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Project description:Scarce data are available to assess sexual behaviour of individuals using antiretroviral pre-exposure prophylaxis for HIV prevention. Increased sexual risk taking by individuals using effective HIV prevention strategies, like pre-exposure prophylaxis, could offset the benefits of HIV prevention. We studied whether the use of pre-exposure prophylaxis in HIV-uninfected men and women in HIV-serodiscordant couples was associated with increased sexual risk behaviour.We undertook a longitudinal analysis of data from the Partners PrEP Study, a double-blind, randomised, placebo-controlled trial of daily oral pre-exposure prophylaxis among HIV-uninfected partners of heterosexual HIV-serodiscordant couples (n=3163, ?18 years of age). Efficacy for HIV prevention was publicly reported in July 2011, and participants continued monthly follow-up thereafter. We used regression analyses to compare the frequency of sex-unprotected by a condom-during the 12 months after compared with the 12 months before July 2011, to assess whether knowledge of pre-exposure prophylaxis efficacy for HIV prevention caused increased sexual risk behaviour.We analysed 56?132 person-months from 3024 HIV-uninfected individuals (64% male). The average frequency of unprotected sex with the HIV-infected study partner was 59 per 100 person-months before unmasking versus 53 after unmasking; we recorded no immediate change (p=0·66) or change over time (p=0·25) after July, 2011. We identified a significant increase in unprotected sex with outside partners after July, 2011, but the effect was small (average of 6·8 unprotected sex acts per year vs 6·2 acts in a predicted counterfactual scenario had patients remained masked, p=0·04). Compared with before July, 2011, we noted no significant increase in incident sexually transmitted infections or pregnancy after July, 2011.Pre-exposure prophylaxis, provided as part of a comprehensive prevention package, might not result in substantial changes in risk-taking sexual behaviour by heterosexual couples.The Bill & Melinda Gates Foundation and the US National Institute of Mental Health.

Project description:Background and objectivesSexual satisfaction is an important part of sexual health and overall well-being. A large number of older people continue to be sexually active, and many are satisfied with their sex life. However, little is known about whether sexual satisfaction differs according to sexual orientation. Therefore, the aim of the study was to investigate whether sexual satisfaction differs according to sexual orientation in later life.Research design and methodsThe German Ageing Survey is a nationally representative study of the German population aged 40+. In the third wave (2008), data on both sexual orientation (heterosexual, homosexual, bisexual, other) and sexual satisfaction (1-very dissatisfied to 5-very satisfied) were collected. Multiple regression analyses with sampling weights were performed (stratified by age: 40-64; 65+).ResultsWe included 4,856 individuals in our analysis (mean age 57.6 ± 11.6; 40-85 years, 50.4% were women, 92.3% (n = 4,483) were heterosexual, and 7.7% (n = 373) were sexual minority adults). In sum, 55.9% of heterosexual individuals and 52.3% of sexual minority adults were satisfied or very satisfied with their sex life. Multiple regression analysis showed that sexual orientation was not significantly associated with sexual satisfaction among both middle-aged (β = 0.07; p = .45) and older adults (β = 0.01; p = .87). Higher sexual satisfaction was associated with lower loneliness scores, partnership satisfaction, importance of sexuality and intimacy, and better health status.Discussion and implicationsOur analysis showed that sexual orientation was not significantly associated with sexual satisfaction among both middle-aged and older adults. Lower loneliness, better health status, and partnership satisfaction significantly contributed to higher sexual satisfaction. Approximately 45% of older individuals (aged 65 years and older), regardless of their sexual orientation, were still satisfied with their sex life.

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Heterosexual risk of HIV transmission per sexual act under combined antiretroviral therapy: systematic review and bayesian modeling.

Publications

Heterosexual risk of HIV transmission per sexual act under combined antiretroviral therapy: systematic review and bayesian modeling.

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