Nav: Home

Study examines risk of HIV transmission from condomless sex with virologically suppressed HIV infection

July 12, 2016

Among nearly 900 serodifferent (one partner is HIV-positive, one is HIV-negative) heterosexual and men who have sex with men couples in which the HIV-positive partner was using suppressive antiretroviral therapy and who reported condomless sex, during a median follow-up of 1.3 years per couple, there were no documented cases of within-couple HIV transmission, according to a study appearing in the July 12 issue of JAMA, an HIV/AIDS theme issue.

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. Alison J. Rodger, M.D., of University College London, and colleagues evaluated 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. The study was conducted at 75 clinical sites in 14 European countries and enrolled 1,166 HIV serodifferent couples (HIV-positive partner taking suppressive ART) (September 2010 to May 2014).

Among the 1,166 enrolled couples, 888 (62 percent heterosexual, 38 percent MSM) provided 1,238 eligible couple-years of follow-up (median follow-up, 1.3 years). At study entry, couples reported condomless sex for a median of 2 years. Condomless sex with other partners was reported by 108 HIV-negative MSM (33 percent) and 21 heterosexuals (4 percent). During follow-up, couples reported condomless sex a median of 37 times per year, 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 (molecular characteristics that indicate whether a virus is similar or different from another) linked transmissions occurred over eligible couple-years of follow-up, giving a rate of within-couple HIV transmission of zero.

The authors note that the confidence limits used in the study suggest that with eligible couple-years accrued so far, appreciable levels of risk cannot be excluded, particularly for anal sex and when considered from the perspective of a cumulative risk over several years.

"Although these results cannot directly provide an answer to the question of whether it is safe for serodifferent couples to practice condomless sex, this study provides informative data (especially for heterosexuals) for couples to base their personal acceptability of risk on."

The researchers note that additional longer-term follow-up is necessary to provide a similar level of confidence for the risk from anal sex compared to vaginal sex.

(doi:10.1001/jama.2016.5148; the study is available pre-embargo to the media at the For the Media website)

Editor's Note: This work was funded by the National Institute for Health Research under its Programme Grants for Applied Research Programme. The study coordinating centre was also supported by the Danish National Research Foundation. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, etc.

Editorial: Condomless Sex With Virologically Suppressed HIV-Infected Individuals - How Safe Is It?

"For individuals who want to routinely or intermittently not use condoms with an HIV-infected partner, clinicians can indicate that the risk of HIV transmission appears small in the setting of continued viral suppression, emphasizing that the duration the HIV-infected partner needs to be virologically suppressed before achieving optimal protection is unknown, although appears to be for at least 6 months, based on the best available data," write Eric S. Daar, M.D., and Katya Corado, M.D., of the Harbor-UCLA Medical Center, Torrance, Calif., in an accompanying editorial.

"Moreover, clinicians need to be clear that even though the overall risk for HIV transmission may be small, the risk is not zero and the actual number is not known, especially for higher-risk groups such as MSM. Although more research is needed with larger numbers of couples and longer follow-up, it is not known if or when such data will emerge. Consequently, for now, clinicians and public health officials must share the data that exist in an honest and understandable way so that serodiscordant couples can be fully informed when individualizing their decision making about sexual practices."

(doi:10.1001/jama.2016.5636; the study is available pre-embargo to the media at the For the Media website)

Editor's Note: Please see the article for additional information, including financial disclosures, funding and support, etc.
-end-
Media Advisory: To contact Alison J. Rodger, M.D., email alison.rodger@ucl.ac.uk. To contact editorial co-author Eric S. Daar, M.D., email edaar@labiomed.org.

To place an electronic embedded link to this study and editorial in your story These links will be live at the embargo time: http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2016.5148http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2016.5636

The JAMA Network Journals

Related Hiv Articles:

The Lancet HIV: Severe anti-LGBT legislations associated with lower testing and awareness of HIV in African countries
This first systematic review to investigate HIV testing, treatment and viral suppression in men who have sex with men in Africa finds that among the most recent studies (conducted after 2011) only half of men have been tested for HIV in the past 12 months.
The Lancet HIV: Tenfold increase in number of adolescents on HIV treatment in South Africa since 2010, but many still untreated
A new study of more than 700,000 one to 19-year olds being treated for HIV infection suggests a ten-fold increase in the number of adolescents aged 15 to 19 receiving HIV treatment in South Africa, according to results published in The Lancet HIV journal.
Starting HIV treatment in ERs may be key to ending HIV spread worldwide
In a follow-up study conducted in South Africa, Johns Hopkins Medicine researchers say they have evidence that hospital emergency departments (EDs) worldwide may be key strategic settings for curbing the spread of HIV infections in hard-to-reach populations if the EDs jump-start treatment and case management as well as diagnosis of the disease.
NIH HIV experts prioritize research to achieve sustained ART-free HIV remission
Achieving sustained remission of HIV without life-long antiretroviral therapy (ART) is a top HIV research priority, according to a new commentary in JAMA by experts at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.
First ever living donor HIV-to-HIV kidney transplant
For the first time, a person living with HIV has donated a kidney to a transplant recipient also living with HIV.
The Lancet HIV: PrEP implementation is associated with a rapid decline in new HIV infections
Study from Australia is the first to evaluate a population-level roll-out of pre-exposure prophylaxis (PrEP) in men who have sex with men.
Researchers date 'hibernating' HIV strains, advancing BC's leadership in HIV cure research
Researchers have developed a novel way for dating 'hibernating' HIV strains, in an advancement for HIV cure research.
HIV RNA expression inhibitors may restore immune function in HIV-infected individuals
Immune activation and inflammation persist in the majority of treated HIV-infected individuals and is associated with excess risk of mortality and morbidity.
HIV vaccine elicits antibodies in animals that neutralize dozens of HIV strains
An experimental vaccine regimen based on the structure of a vulnerable site on HIV elicited antibodies in mice, guinea pigs and monkeys that neutralize dozens of HIV strains from around the world.
State-of-the-art HIV drug could curb HIV transmission, improve survival in India
An HIV treatment regimen already widely used in North America and Europe would likely increase the life expectancy of people living with HIV in India by nearly three years and reduce the number of new HIV infections by 23 percent with minimal impact on the country's HIV/AIDS budget.
More Hiv News and Hiv Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Rethinking Anger
Anger is universal and complex: it can be quiet, festering, justified, vengeful, and destructive. This hour, TED speakers explore the many sides of anger, why we need it, and who's allowed to feel it. Guests include psychologists Ryan Martin and Russell Kolts, writer Soraya Chemaly, former talk radio host Lisa Fritsch, and business professor Dan Moshavi.
Now Playing: Science for the People

#538 Nobels and Astrophysics
This week we start with this year's physics Nobel Prize awarded to Jim Peebles, Michel Mayor, and Didier Queloz and finish with a discussion of the Nobel Prizes as a way to award and highlight important science. Are they still relevant? When science breakthroughs are built on the backs of hundreds -- and sometimes thousands -- of people's hard work, how do you pick just three to highlight? Join host Rachelle Saunders and astrophysicist, author, and science communicator Ethan Siegel for their chat about astrophysics and Nobel Prizes.