Viral suppression and HIV transmission in serodiscordant male couples: an international, prospective, observational, cohort study

Opposites Attract Study Group

Research output: Contribution to journalArticle

Abstract

Background: Evidence on viral load and HIV transmission risk in HIV-serodiscordant male homosexual couples is limited to one published study. We calculated transmission rates in couples reporting condomless anal intercourse (CLAI), when HIV-positive partners were virally suppressed, and daily pre-exposure prophylaxis (PrEP) was not used by HIV-negative partners. Methods: In the Opposites Attract observational cohort study, serodiscordant male homosexual couples were recruited from 13 clinics in Australia, one in Brazil, and one in Thailand. At study visits, HIV-negative partners provided information on sexual behaviour and were tested for HIV and sexually transmitted infections; HIV-positive partners had HIV viral load tests, CD4 cell count, and sexually transmitted infection tests done. Viral suppression was defined as less than 200 copies per mL. Linked within-couple HIV transmissions were identified with phylogenetic analysis. Incidence was calculated per couple-year of follow-up, focusing on periods with CLAI, no use of daily PrEP, and viral suppression. One-sided upper 95% CI limits for HIV transmission rates were calculated with exact Poisson methods. Findings: From May 8, 2012, to March 31, 2016, in Australia, and May 7, 2014, to March 31, 2016, in Brazil and Thailand, 358 couples were enrolled. 343 couples had at least one follow-up visit and were followed up for 588·4 couple-years. 258 (75%) of 343 HIV-positive partners had viral loads consistently less than 200 copies per mL and 115 (34%) of 343 HIV-negative partners used daily PrEP during follow-up. 253 (74%) of 343 couples reported within-couple CLAI during follow-up, with a total of 16 800 CLAI acts. Three new HIV infections occurred but none were phylogenetically linked. There were 232·2 couple-years of follow-up and 12 447 CLAI acts in periods when CLAI was reported, HIV-positive partners were virally suppressed, and HIV-negative partners did not use daily PrEP, resulting in an upper CI limit of 1·59 per 100 couple-years of follow-up for transmission rate. Interpretation: HIV treatment as prevention is effective in men who have sex with men. Increasing HIV testing and linking to immediate treatment is an important strategy in HIV prevention in homosexual men. Funding: National Health and Medical Research Council; amfAR, The Foundation for AIDS Research; ViiV Healthcare; and Gilead Sciences.

Original languageEnglish (US)
Pages (from-to)e438-e447
JournalThe Lancet HIV
Volume5
Issue number8
DOIs
StatePublished - Aug 1 2018

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Observational Studies
Cohort Studies
HIV
Viral Load
Thailand
Sexually Transmitted Diseases
Brazil
CD4 Lymphocyte Count
Sexual Behavior
HIV Infections
Biomedical Research
Acquired Immunodeficiency Syndrome

ASJC Scopus subject areas

  • Epidemiology
  • Immunology
  • Infectious Diseases
  • Virology

Cite this

Viral suppression and HIV transmission in serodiscordant male couples : an international, prospective, observational, cohort study. / Opposites Attract Study Group.

In: The Lancet HIV, Vol. 5, No. 8, 01.08.2018, p. e438-e447.

Research output: Contribution to journalArticle

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abstract = "Background: Evidence on viral load and HIV transmission risk in HIV-serodiscordant male homosexual couples is limited to one published study. We calculated transmission rates in couples reporting condomless anal intercourse (CLAI), when HIV-positive partners were virally suppressed, and daily pre-exposure prophylaxis (PrEP) was not used by HIV-negative partners. Methods: In the Opposites Attract observational cohort study, serodiscordant male homosexual couples were recruited from 13 clinics in Australia, one in Brazil, and one in Thailand. At study visits, HIV-negative partners provided information on sexual behaviour and were tested for HIV and sexually transmitted infections; HIV-positive partners had HIV viral load tests, CD4 cell count, and sexually transmitted infection tests done. Viral suppression was defined as less than 200 copies per mL. Linked within-couple HIV transmissions were identified with phylogenetic analysis. Incidence was calculated per couple-year of follow-up, focusing on periods with CLAI, no use of daily PrEP, and viral suppression. One-sided upper 95{\%} CI limits for HIV transmission rates were calculated with exact Poisson methods. Findings: From May 8, 2012, to March 31, 2016, in Australia, and May 7, 2014, to March 31, 2016, in Brazil and Thailand, 358 couples were enrolled. 343 couples had at least one follow-up visit and were followed up for 588·4 couple-years. 258 (75{\%}) of 343 HIV-positive partners had viral loads consistently less than 200 copies per mL and 115 (34{\%}) of 343 HIV-negative partners used daily PrEP during follow-up. 253 (74{\%}) of 343 couples reported within-couple CLAI during follow-up, with a total of 16 800 CLAI acts. Three new HIV infections occurred but none were phylogenetically linked. There were 232·2 couple-years of follow-up and 12 447 CLAI acts in periods when CLAI was reported, HIV-positive partners were virally suppressed, and HIV-negative partners did not use daily PrEP, resulting in an upper CI limit of 1·59 per 100 couple-years of follow-up for transmission rate. Interpretation: HIV treatment as prevention is effective in men who have sex with men. Increasing HIV testing and linking to immediate treatment is an important strategy in HIV prevention in homosexual men. Funding: National Health and Medical Research Council; amfAR, The Foundation for AIDS Research; ViiV Healthcare; and Gilead Sciences.",
author = "{Opposites Attract Study Group} and Bavinton, {Benjamin R.} and Pinto, {Angie N.} and Nittaya Phanuphak and Beatriz Grinsztejn and Prestage, {Garrett P.} and Zablotska-Manos, {Iryna B.} and Fengyi Jin and Fairley, {Christopher K.} and Richard Moore and Norman Roth and Mark Bloch and Catherine Pell and McNulty, {Anna M.} and David Baker and Jennifer Hoy and Tee, {Ban Kiem} and Templeton, {David J.} and Cooper, {David A.} and Sean Emery and Anthony Kelleher and Grulich, {Andrew E.} and Grulich, {Andrew E.} and Zablotska-Manos, {Iryna B.} and Prestage, {Garrett P.} and Fengyi Jin and Bavinton, {Benjamin R.} and Beatriz Grinsztejn and Nittaya Phanuphak and Cooper, {David A.} and Anthony Kelleher and Sean Emery and Fairley, {Christopher K.} and David Wilson and Koelsch, {Kersten K.} and Kathy Triffitt and Nicolas Doong and David Baker and Mark Bloch and Templeton, {David J.} and Anna McNulty and Moore, {Richard D} and Jennifer Hoy and Tee, {Ban Kiem} and Richard Moore and Norman Roth and David Orth and Pinto, {Angie N.}",
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T1 - Viral suppression and HIV transmission in serodiscordant male couples

T2 - an international, prospective, observational, cohort study

AU - Opposites Attract Study Group

AU - Bavinton, Benjamin R.

AU - Pinto, Angie N.

AU - Phanuphak, Nittaya

AU - Grinsztejn, Beatriz

AU - Prestage, Garrett P.

AU - Zablotska-Manos, Iryna B.

AU - Jin, Fengyi

AU - Fairley, Christopher K.

AU - Moore, Richard

AU - Roth, Norman

AU - Bloch, Mark

AU - Pell, Catherine

AU - McNulty, Anna M.

AU - Baker, David

AU - Hoy, Jennifer

AU - Tee, Ban Kiem

AU - Templeton, David J.

AU - Cooper, David A.

AU - Emery, Sean

AU - Kelleher, Anthony

AU - Grulich, Andrew E.

AU - Grulich, Andrew E.

AU - Zablotska-Manos, Iryna B.

AU - Prestage, Garrett P.

AU - Jin, Fengyi

AU - Bavinton, Benjamin R.

AU - Grinsztejn, Beatriz

AU - Phanuphak, Nittaya

AU - Cooper, David A.

AU - Kelleher, Anthony

AU - Emery, Sean

AU - Fairley, Christopher K.

AU - Wilson, David

AU - Koelsch, Kersten K.

AU - Triffitt, Kathy

AU - Doong, Nicolas

AU - Baker, David

AU - Bloch, Mark

AU - Templeton, David J.

AU - McNulty, Anna

AU - Moore, Richard D

AU - Hoy, Jennifer

AU - Tee, Ban Kiem

AU - Moore, Richard

AU - Roth, Norman

AU - Orth, David

AU - Pinto, Angie N.

PY - 2018/8/1

Y1 - 2018/8/1

N2 - Background: Evidence on viral load and HIV transmission risk in HIV-serodiscordant male homosexual couples is limited to one published study. We calculated transmission rates in couples reporting condomless anal intercourse (CLAI), when HIV-positive partners were virally suppressed, and daily pre-exposure prophylaxis (PrEP) was not used by HIV-negative partners. Methods: In the Opposites Attract observational cohort study, serodiscordant male homosexual couples were recruited from 13 clinics in Australia, one in Brazil, and one in Thailand. At study visits, HIV-negative partners provided information on sexual behaviour and were tested for HIV and sexually transmitted infections; HIV-positive partners had HIV viral load tests, CD4 cell count, and sexually transmitted infection tests done. Viral suppression was defined as less than 200 copies per mL. Linked within-couple HIV transmissions were identified with phylogenetic analysis. Incidence was calculated per couple-year of follow-up, focusing on periods with CLAI, no use of daily PrEP, and viral suppression. One-sided upper 95% CI limits for HIV transmission rates were calculated with exact Poisson methods. Findings: From May 8, 2012, to March 31, 2016, in Australia, and May 7, 2014, to March 31, 2016, in Brazil and Thailand, 358 couples were enrolled. 343 couples had at least one follow-up visit and were followed up for 588·4 couple-years. 258 (75%) of 343 HIV-positive partners had viral loads consistently less than 200 copies per mL and 115 (34%) of 343 HIV-negative partners used daily PrEP during follow-up. 253 (74%) of 343 couples reported within-couple CLAI during follow-up, with a total of 16 800 CLAI acts. Three new HIV infections occurred but none were phylogenetically linked. There were 232·2 couple-years of follow-up and 12 447 CLAI acts in periods when CLAI was reported, HIV-positive partners were virally suppressed, and HIV-negative partners did not use daily PrEP, resulting in an upper CI limit of 1·59 per 100 couple-years of follow-up for transmission rate. Interpretation: HIV treatment as prevention is effective in men who have sex with men. Increasing HIV testing and linking to immediate treatment is an important strategy in HIV prevention in homosexual men. Funding: National Health and Medical Research Council; amfAR, The Foundation for AIDS Research; ViiV Healthcare; and Gilead Sciences.

AB - Background: Evidence on viral load and HIV transmission risk in HIV-serodiscordant male homosexual couples is limited to one published study. We calculated transmission rates in couples reporting condomless anal intercourse (CLAI), when HIV-positive partners were virally suppressed, and daily pre-exposure prophylaxis (PrEP) was not used by HIV-negative partners. Methods: In the Opposites Attract observational cohort study, serodiscordant male homosexual couples were recruited from 13 clinics in Australia, one in Brazil, and one in Thailand. At study visits, HIV-negative partners provided information on sexual behaviour and were tested for HIV and sexually transmitted infections; HIV-positive partners had HIV viral load tests, CD4 cell count, and sexually transmitted infection tests done. Viral suppression was defined as less than 200 copies per mL. Linked within-couple HIV transmissions were identified with phylogenetic analysis. Incidence was calculated per couple-year of follow-up, focusing on periods with CLAI, no use of daily PrEP, and viral suppression. One-sided upper 95% CI limits for HIV transmission rates were calculated with exact Poisson methods. Findings: From May 8, 2012, to March 31, 2016, in Australia, and May 7, 2014, to March 31, 2016, in Brazil and Thailand, 358 couples were enrolled. 343 couples had at least one follow-up visit and were followed up for 588·4 couple-years. 258 (75%) of 343 HIV-positive partners had viral loads consistently less than 200 copies per mL and 115 (34%) of 343 HIV-negative partners used daily PrEP during follow-up. 253 (74%) of 343 couples reported within-couple CLAI during follow-up, with a total of 16 800 CLAI acts. Three new HIV infections occurred but none were phylogenetically linked. There were 232·2 couple-years of follow-up and 12 447 CLAI acts in periods when CLAI was reported, HIV-positive partners were virally suppressed, and HIV-negative partners did not use daily PrEP, resulting in an upper CI limit of 1·59 per 100 couple-years of follow-up for transmission rate. Interpretation: HIV treatment as prevention is effective in men who have sex with men. Increasing HIV testing and linking to immediate treatment is an important strategy in HIV prevention in homosexual men. Funding: National Health and Medical Research Council; amfAR, The Foundation for AIDS Research; ViiV Healthcare; and Gilead Sciences.

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