Sexual Activity Without Condoms and Risk of HIV Transmission in Serodifferent Couples When the HIV-Positive Partner Is Using Suppressive Antiretroviral Therapy
Sexual Activity Without Condoms and Risk of HIV Transmission in Serodifferent Couples When the HIV-Positive Partner Is Using Suppressive Antiretroviral Therapy
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DOI：
10.1001/jama.2016.5148
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发表时间：
2016-07-12
影响因子：
120.7
通讯作者：
Lundgren, Jens
中科院分区：
文献类型：
--
作者：
Rodger, Alison J.;Cambiano, Valentina;Lundgren, Jens
重要性评估抗逆转录病毒疗法(ART)作为预防策略的有效性和成本效益的一个关键因素是通过无避孕套的性行为传播HIV的绝对风险，同时抑制了对肛门和阴道性行为的HIV-1RNA病毒载量。目的评估在不使用避孕套的性行为期间和HIV阳性伴侣的HIV-1RNA载量低于200拷贝/毫升的性行为期间和HIV阳性伴侣的HIV-1RNA载量低于200拷贝/毫升时，夫妻内HIV传播(异性恋和男男性行为[MSM])的比率。观察性伴侣(抗逆转录病毒疗法患者的伴侣--风险的新评估)研究在14个欧洲国家的75个临床地点进行，招募了1166对艾滋病毒血清不同的夫妇(艾滋病毒阳性的伴侣服用抑制性抗逆转录病毒疗法)，他们报告了无套性行为(2010年9月至2014年5月)。纳入两年随访的资格标准是无避孕套性行为和HIV-1RNA载量低于200拷贝/毫升。结果在1166对登记的夫妇中，888对(平均年龄42岁[智商，35-48]；548名异性恋[61.7%]和340名男男性同性恋者[38.3%])提供了1238对符合条件的夫妇的1238对符合条件的夫妇的随访(中位数为1.3年[智商，0.8-2.0])。在基线时，夫妇报告的无套性行为的中位数为2年(IQR，0.5-6.3)。108名HIV阴性男男性接触者(33%)和21名异性恋者(4%)报告了与其他伴侣发生无套性行为的情况。在随访期间，夫妇报告的无套性行为的中位数为每年37次(IQR，15-71次)，男男性接触者夫妇报告的无套性行为约为22000次，异性恋夫妇报告的无套性行为约为36000次。尽管有11名HIV阴性的伴侣成为HIV阳性(10名男男性接触者；1名异性恋；8名报告与其他伴侣发生无公寓性行为)，但在符合条件的夫妇几年的随访中没有发生系统遗传相关的传播，使夫妇内艾滋病毒传播率为零，95%的上限为0.30/100夫妇年的随访。无避孕套肛交的95%可信上限为每100对夫妇0.71例。结论在HIV阳性伴侣使用抑制性抗逆转录病毒疗法并报告无避孕套性行为的不同血清异性恋者和男男性接触者中，在每对夫妇1.3年的中位随访期内，没有记录的夫妇内艾滋病毒传播病例(95%可信上限上限，0.30/100对夫妇年随访)。额外的长期跟踪是必要的，以提供更准确的风险估计。
IMPORTANCE A key factor in assessing the effectiveness and cost-effectiveness of antiretroviral therapy (ART) as a prevention strategy is the absolute risk of HIV transmission through condomless sex with suppressed HIV-1 RNA viral load for both anal and vaginal sex.OBJECTIVE To evaluate the rate of within-couple HIV transmission (heterosexual and men who have sex with men [MSM]) during periods of sex without condoms and when the HIV-positive partner had HIV-1 RNA load less than 200 copies/mL.DESIGN, SETTING, AND PARTICIPANTS The prospective, observational PARTNER (Partners of People on ART-A New Evaluation of the Risks) study was conducted at 75 clinical sites in 14 European countries and enrolled 1166 HIV serodifferent couples (HIV-positive partner taking suppressive ART) who reported condomless sex (September 2010 to May 2014). Eligibility criteria for inclusion of couple-years of follow-up were condomless sex and HIV-1 RNA load less than 200 copies/mL. Anonymized phylogenetic analysis compared couples' HIV-1 polymerase and envelope sequences if an HIV-negative partner became infected to determine phylogenetically linked transmissions.EXPOSURES Condomless sexual activity with an HIV-positive partner taking virally suppressive ART.MAIN OUTCOMES AND MEASURES Risk of within-couple HIV transmission to the HIV-negative partnerRESULTS Among 1166 enrolled couples, 888 (mean age, 42 years [IQR, 35-48]; 548 heterosexual [61.7%] and 340 MSM [38.3%]) provided 1238 eligible couple-years of follow-up (median follow-up, 1.3 years [IQR, 0.8-2.0]). At baseline, couples reported condomless sex for a median of 2 years (IQR, 0.5-6.3). Condomless sex with other partners was reported by 108 HIV-negative MSM (33%) and 21 heterosexuals (4%). During follow-up, couples reported condomless sex a median of 37 times per year (IQR, 15-71), with MSM couples reporting approximately 22 000 condomless sex acts and heterosexuals approximately 36 000. Although 11 HIV-negative partners became HIV-positive (10 MSM; 1 heterosexual; 8 reported condomless sex with other partners), no phylogenetically linked transmissions occurred over eligible couple-years of follow-up, giving a rate of within-couple HIV transmission of zero, with an upper 95% confidence limit of 0.30/100 couple-years of follow-up. The upper 95% confidence limit for condomless anal sex was 0.71 per 100 couple-years of follow-up.CONCLUSIONS AND RELEVANCE Among serodifferent heterosexual and MSM couples in which the HIV-positive partner was using suppressive ART and who reported condomless sex, during median follow-up of 1.3 years per couple, there were no documented cases of within-couple HIV transmission (upper 95% confidence limit, 0.30/100 couple-years of follow-up). Additional longer-term follow-up is necessary to provide more precise estimates of risk.