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No HIV transmission from condomless sex when partner is on ART, study shows
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BMJ (Published 13 July 2016)
Jacqui Wise London
Gay men and heterosexual people with HIV do not transmit the virus to their partner if they are on suppressive antiretroviral treatment (ART) even when they have sex without a condom, according to research published in JAMA.1
The PARTNER (Partners of people on ART) study was conducted in 14 European countries and included 888 couples where one partner was HIV positive and the other was HIV negative. The study, which was funded by the National Institute for Health Research, included 548 heterosexual couples and 340 male couples who reported routinely having sex without a condom. The HIV positive partner was receiving ART and had an HIV-1 RNA load of fewer than 200 copies/ml. During follow-up, couples reported having sex without a condom a median of 37 times a year.
After a median follow-up of 1.3 years, 11 HIV negative partners became HIV positive. However, there were no cases of within couple HIV transmission: when the HIV virus was analysed it was shown to come from someone other than the partner under treatment. Ten of the 11 who became HIV positive during follow-up were gay men and one was heterosexual. Eight reported that they had had condomless sex with other partners.
Anna Geretti from the University of Liverpool's institute of infection and global health said, "The HIV virus can be divided into several subgroups, each with its own genetic characteristics, and this makes it possible to see whether the virus is genetically similar to a partner's. In all cases the results showed that the virus came from someone other than the partner under treatment."
However, despite a zero rate of within couple HIV transmission, the upper 95% confidence limit for within couple transmissions per 100 eligible couple years of follow-up for heterosexuals was 0.97 for the male HIV positive/female HIV negative couple group, 0.88 for the female HIV positive/male HIV negative couple group, and 0.84 for the men who have sex with men couple group. For persons engaging in receptive anal sex with ejaculation inside the uninfected partner, the upper 95% confidence limit for within couple HIV transmission was 2.7 per 100 couple years of follow-up; however, this estimate was based on relatively small numbers, because only 45% reported this type of sexual behaviour. The authors note that appreciable levels of risk cannot be excluded, particularly for anal sex, and longer follow-up is needed. The results of the second part of the PARTNER study, which will monitor only gay men, are expected in 2018.
Senior study author, Jens Lundgren, head of the Centre for Health and Infectious Diseases in Copenhagen, said, "The results clearly show that early diagnosis of HIV and access to effective treatment are crucial for reducing the number of new HIV cases. As soon as a patient with HIV is on treatment with a suppressed viral load, the risk of transmission becomes minimal."
1. Rodger AJ, Cambiano V, Bruun T, et al. PARTNER Study Group. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA2016;316:171-81. doi:10.1001/jama.2016.5148. pmid:27404185. CrossRefMedline
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