{"id":1205,"date":"2016-09-08T14:26:38","date_gmt":"2016-09-08T13:26:38","guid":{"rendered":"https:\/\/blogs.bmj.com\/sti\/?p=1205"},"modified":"2016-09-08T14:26:38","modified_gmt":"2016-09-08T13:26:38","slug":"viral-suppression-through-art-prevents-hiv-transmission-between-long-term-sero-different-msm-and-heterosexual-partners-regardless-of-condom-use","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/sti\/2016\/09\/08\/viral-suppression-through-art-prevents-hiv-transmission-between-long-term-sero-different-msm-and-heterosexual-partners-regardless-of-condom-use\/","title":{"rendered":"Viral suppression through ART prevents HIV transmission between long-term sero-different MSM and heterosexual partners regardless of condom use"},"content":{"rendered":"

The HPTN 052 study demonstrated the preventative benefit of ART, showing a dramatic 96% reduction in HIV transmission in HIV+ participants randomized to early ART initiation compared with the group that deferred treatment. \u00a0This is very encouraging.\u00a0 But from the perspective of a gay person considering the risk of engaging in condomless sex with a long-term HIV+ partner, these results do not provide an adequate basis on which to make a decision.\u00a0 For a start, HPTN 052, like other such studies, focuses largely on heterosexual couples engaging in vaginal sex \u2013 which is recognized to carry only a fraction (c. 0.1) of the risk of HIV transmission of anal sex. \u00a0Besides, the study reports high levels (93%) of condom use.\u00a0 Much remains obscure, therefore, as to the level of protection that a gay person could reasonably expect from ART against HIV transmission through condomless anal sex with a long-term partner.<\/p>\n

This question is squarely addressed, however, in a recently reported prospective observational study \u2013 PARTNER (Partners of People on ART \u2013 A New Evaluation of the Risks) \u2013 involving 888 sero-different MSM (330) and heterosexual (548) couples reporting condomless sex who contributed a total of 1,238 eligible couple-years.\u00a0 This study did not limit itself to establishing cases of transmission, but conducted phylogenetic analysis in those cases in order to determine whether or not the transmission had resulted from sex with the long-term partner.\u00a0 Of the 11 transmissions that took place in the course of the 1,238 couple-years (10 amongst heterosexual, one amongst the MSM, couples), none<\/strong> were found to be phylogenetically linked.\u00a0 The paper also examined the association between the HIV transmission which did take place (i.e. not from primary partner) and the sexual behaviours reported by HIV- partners.\u00a0 Not surprisingly, this was found to be elevated in heterosexual couples where anal sex was reported, and in MSM where anal sex was receptive and receptive with ejaculation (1.68 and 2.70 per 100 couple-years, respectively).<\/p>\n

With the couple-years accrued hitherto, appreciable levels of risk over the long-term, especially with anal sex, cannot yet be excluded: a rate of 2.2 per 100 couple-years remains the upper limit (20% over ten years) \u2013 though, of course, the risks could prove to be considerably lower than this.\u00a0\u00a0 With a view to arriving at a more precise estimation, the MSM side of the PARTNERS study remains ongoing.\u00a0 So far, however, the news seems to be good.<\/p>\n

Aside from its implications for personal decision-making about condom use, the question of the preventative effectiveness of ART could presumably also have relevance for health policy decisions affecting resource allocation that involve determining the relative priority to be accorded to interventions promoting engagement and retention in treatment as against other interventions (e.g. PrEP) (Punyacharoensin & White\/STIs\/blog<\/a>;\u00a0NHS kicks PrEP into the long grass\/STIs\/blogs<\/a>).\u00a0The greater the effectiveness of viral suppression through ART as an HIV prevention tool, the better the case for prioritizing interventions to achieve higher targets for engagement and retention in treatment.<\/p>\n","protected":false},"excerpt":{"rendered":"

The HPTN 052 study demonstrated the preventative benefit of ART, showing a dramatic 96% reduction in HIV transmission in HIV+ participants randomized to early ART initiation compared with the group that deferred treatment. \u00a0This is very encouraging.\u00a0 But from the perspective of a gay person considering the risk of engaging in condomless sex with a […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":152,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[13992,16491,4352],"tags":[],"class_list":["post-1205","post","type-post","status-publish","format-standard","hentry","category-hiv-prevention","category-phylogenetic-analysis","category-preventative-effect-of-art"],"yoast_head":"\nViral suppression through ART prevents HIV transmission between long-term sero-different MSM and heterosexual partners regardless of condom use - Sexually Transmitted Infections<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/sti\/2016\/09\/08\/viral-suppression-through-art-prevents-hiv-transmission-between-long-term-sero-different-msm-and-heterosexual-partners-regardless-of-condom-use\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Viral suppression through ART prevents HIV transmission between long-term sero-different MSM and heterosexual partners regardless of condom use - Sexually Transmitted Infections\" \/>\n<meta property=\"og:description\" content=\"The HPTN 052 study demonstrated the preventative benefit of ART, showing a dramatic 96% reduction in HIV transmission in HIV+ participants randomized to early ART initiation compared with the group that deferred treatment. \u00a0This is very encouraging.\u00a0 But from the perspective of a gay person considering the risk of engaging in condomless sex with a [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/sti\/2016\/09\/08\/viral-suppression-through-art-prevents-hiv-transmission-between-long-term-sero-different-msm-and-heterosexual-partners-regardless-of-condom-use\/\" \/>\n<meta property=\"og:site_name\" content=\"Sexually Transmitted Infections\" \/>\n<meta property=\"article:published_time\" content=\"2016-09-08T13:26:38+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2016\\\/09\\\/08\\\/viral-suppression-through-art-prevents-hiv-transmission-between-long-term-sero-different-msm-and-heterosexual-partners-regardless-of-condom-use\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2016\\\/09\\\/08\\\/viral-suppression-through-art-prevents-hiv-transmission-between-long-term-sero-different-msm-and-heterosexual-partners-regardless-of-condom-use\\\/\"},\"author\":{\"name\":\"\",\"@id\":\"\"},\"headline\":\"Viral suppression through ART prevents HIV transmission between long-term sero-different MSM and heterosexual partners regardless of condom use\",\"datePublished\":\"2016-09-08T13:26:38+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2016\\\/09\\\/08\\\/viral-suppression-through-art-prevents-hiv-transmission-between-long-term-sero-different-msm-and-heterosexual-partners-regardless-of-condom-use\\\/\"},\"wordCount\":496,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/#organization\"},\"articleSection\":[\"HIV prevention\",\"Phylogenetic analysis\",\"Preventative effect of ART\"],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2016\\\/09\\\/08\\\/viral-suppression-through-art-prevents-hiv-transmission-between-long-term-sero-different-msm-and-heterosexual-partners-regardless-of-condom-use\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2016\\\/09\\\/08\\\/viral-suppression-through-art-prevents-hiv-transmission-between-long-term-sero-different-msm-and-heterosexual-partners-regardless-of-condom-use\\\/\",\"name\":\"Viral suppression through ART prevents HIV transmission between long-term sero-different MSM and heterosexual partners regardless of condom use - 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