Decrease in sexual risk behaviours after early initiation of antiretroviral therapy: a 24‐month prospective study in Côte d'Ivoire

Abstract

IntroductionWhether early antiretroviral therapy (ART) initiation could impact sexual risk behaviours remains to be documented. We aimed to investigate changes in sexual behaviours within the 24 months following an early versus standard ART initiation in HIV-positive adults with high CD4 counts.MethodsWe used data from a prospective behavioural study nested in a randomized controlled trial of early ART (Temprano-ANRS12136). Time trends in sexual behaviours from enrolment in the trial (M0) to 12-month (M12) and 24-month (M24) visits were measured and compared, using Generalized Estimating Equations models, between participants randomly assigned either to initiate ART immediately (early ART) or to defer ART initiation until on-going WHO starting criteria are met (standard ART). Indicators of sexual behaviours included 1) sexual activity in the past year, 2) multiple partnership in the past year, 3) unprotected sex at last intercourse and 4) risky sex (i.e. unprotected sex with a partner of HIV negative/unknown status) at last intercourse.ResultsAnalyses included 1952 participants (975 with early ART and 977 with standard ART; overall median baseline CD4 count: 469/mm3). Among participants with early ART, significant decreases were found between M0 and M24 in sexual activity (Odds Ratio [OR] 0.72, 95% Confidence Interval [95% CI] 0.57–0.92), multiple partnership (OR 0.57, 95% CI 0.41–0.79), unprotected sex (OR 0.59, 95% CI 0.47–0.75) and risky sex (OR 0.58, 95% CI 0.45–0.76). Among participants with standard ART, sexual behaviours showed similar trends over time. These decreases mostly occurred within the 12 months following enrolment in the trial in both groups and prior to ART initiation in participants with standard ART. For unprotected sex and risky sex, decreases were or tended to be more pronounced among patients reporting that their last sexual partner was non-cohabiting.ConclusionsIn these sub-Saharan adults with high CD4 counts, entry into HIV care, rather than ART initiation, resulted in decreased sexual activity and risky sexual behaviours. We did not observe any evidence of a risk compensation phenomenon associated with early ART initiation. These results illustrate the potential behavioural preventive effect of early entry into care, which goes hand in hand with early ART initiation.

Antiretroviral Therapy Initiation Is Not Associated With Risky Sexual Behavior Among Heterosexual Human Immunodeficiency Virus–Infected Persons in Serodiscordant Partnerships

“…Our finding that HIV-infected women and men were significantly less likely to self-report condomless sex with primary partners after starting ART, is similar to previous reports (14–24). A meta-analysis of 14 studies of sexual behavior and ART use in sub-Saharan Africa (25) identified only four studies (16, 17, 19, 22) that reported rates of unprotected sex with HIV-uninfected or unknown status partners.…”

Early antiretroviral therapy initiation in west Africa has no adverse social consequences

“…These results have been obtained within a trial that documented strong clinical individual benefits of early ART alongside evidence for reduced sexual risk behaviors following early entry into care and decreased risk of transmission due to the effect of ARTon viral load [1,15,21]. As a whole, these results show that early ART in a west African context appears to combine clinical and preventive benefits that are not impaired by potential adverse social effects.…”

“…The present socio-behavioral study was nested in the TEMPRANO-ANRS12136 trial, a randomized trial of early ART that was conducted in Abidjan (Côte d'Ivoire) [1,15]. At inclusion, ART-naïve participants presenting no criteria for starting ART were randomized to initiate ART immediately ('early ART') or to defer ART until ongoing WHO criteria for treatment initiation were met ('deferred ART') [16,17].…”

Level of viral suppression and the cascade of HIV care in a South African semi-urban setting in 2012

“…This association may reflect the behavioral preventive effect of ART that has previously been described [37][38][39][40].…”