Less decrease in risk behaviour from pre-HIV to post-HIV seroconversion among MSM in the combination antiretroviral therapy era compared with the pre-combination antiretroviral therapy era

Department of Research, Cluster of Infectious Diseases, Public Health Service Amsterdam, The Netherlands.
AIDS (London, England) (Impact Factor: 5.55). 12/2011; 26(4):489-95. DOI: 10.1097/QAD.0b013e32834f9d7c
Source: PubMed


To gain insight in the ongoing HIV transmission, we compared sexual risk behaviour pre-HIV and post-HIV seroconversion in 206 MSM participating in the Amsterdam Cohort Studies (1984-2008) before and after the introduction of combination antiretroviral therapy (cART).
MSM completed behavioural questionnaires and were tested for HIV antibodies every 6 months. Trends in anal intercourse and number of sex partners from 4 years before HIV seroconversion until 4 years after diagnosis were analysed with latent class random effects logistic regression models.
The risk of having unprotected anal intercourse (UAI) 1 year after HIV diagnosis decreased significantly when compared with 1 year before diagnosis in both the pre-cART era [difference, 30%; 95% confidence interval (CI), 22-36%] and cART era (difference, 19%; 95% CI, 9-30%). In contrast to a continuing decrease of UAI in the pre-cART era, the probability of UAI in the cART era increased again to preseroconversion levels (61%; 95% CI, 48-74%)) 4 years after diagnosis.
This study provides evidence that recently seroconverted MSM reduce their sexual risk behaviour following HIV diagnosis both in the pre-cART as well as the cART period. However, in the cART period this reduction in sexual risk behaviour is less and returns to pre-cART levels within 4 years. These findings not only confirm the need for early HIV testing but also make it clear that much more effort should go into identifying, counselling, and possibly treating recently seroconverted MSM who have been found to be one of the most important drivers of HIV transmission among MSM.

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    • "The incidence of HIV-1 dual infections is increasing in Amsterdam from an absence in early years to 1.0-2.4% in 2003-2007 [79,80]. The clinically unfavourable outcome of dual infection should translate into preventive strategies, in particular because dual infection is associated with risk-taking behaviour that has been reported to increase in recent years [81]. "
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    • "In contrast, women reported decreasing rates of RSB with each year of ART use, which was independent of CD4 and temporal changes. Our findings add data to an emerging theory of sexual behavior trends among PLWHA on ART: namely, that while RSB decreases after initiating ART in most populations [8], [9], that some important sub-populations also appear to report increasing RSB over time, to levels at or near pre-initiation rates [10], [11], [16]. This finding is of critical importance to public health experts working to decrease HIV transmission, and raises important questions about the causes of differing sexual behavior patterns, the role of targeted interventions to sub-populations, and the relationships between RSB and drug adherence. "
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