Jean Kévin, Gabillard Delphine, Moh Raoul, Danel Christine, Desgrées-du-Loû Annabel, N'takpe Jean-Baptiste, Le Carrou Jérôme, Badjé Anani, Eholié Serge, Lert France, Anglaret Xavier, Dray-Spira Rosemary
Epidemiology of Occupational and Social Determinants of Health - Center for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France; UMRS 1018, Université Versailles Saint-Quentin, Villejuif, France;
PAC-CI Program, CHU de Treichville, Abidjan, Côte d'Ivoire; INSERM U897, Université Bordeaux Segalen, Bordeaux, France.
J Int AIDS Soc. 2014 Jun 30;17(1):18977. doi: 10.7448/IAS.17.1.18977. eCollection 2014.
Whether early antiretroviral therapy (ART) initiation could impact sexual risk behaviours remains to be documented. We aimed to investigate changes in sexual behaviours within the 24 months following an early versus standard ART initiation in HIV-positive adults with high CD4 counts.
We used data from a prospective behavioural study nested in a randomized controlled trial of early ART (Temprano-ANRS12136). Time trends in sexual behaviours from enrolment in the trial (M0) to 12-month (M12) and 24-month (M24) visits were measured and compared, using Generalized Estimating Equations models, between participants randomly assigned either to initiate ART immediately (early ART) or to defer ART initiation until on-going WHO starting criteria are met (standard ART). Indicators of sexual behaviours included 1) sexual activity in the past year, 2) multiple partnership in the past year, 3) unprotected sex at last intercourse and 4) risky sex (i.e. unprotected sex with a partner of HIV negative/unknown status) at last intercourse.
Analyses included 1952 participants (975 with early ART and 977 with standard ART; overall median baseline CD4 count: 469/mm(3)). Among participants with early ART, significant decreases were found between M0 and M24 in sexual activity (Odds Ratio [OR] 0.72, 95% Confidence Interval [95% CI] 0.57-0.92), multiple partnership (OR 0.57, 95% CI 0.41-0.79), unprotected sex (OR 0.59, 95% CI 0.47-0.75) and risky sex (OR 0.58, 95% CI 0.45-0.76). Among participants with standard ART, sexual behaviours showed similar trends over time. These decreases mostly occurred within the 12 months following enrolment in the trial in both groups and prior to ART initiation in participants with standard ART. For unprotected sex and risky sex, decreases were or tended to be more pronounced among patients reporting that their last sexual partner was non-cohabiting.
In these sub-Saharan adults with high CD4 counts, entry into HIV care, rather than ART initiation, resulted in decreased sexual activity and risky sexual behaviours. We did not observe any evidence of a risk compensation phenomenon associated with early ART initiation. These results illustrate the potential behavioural preventive effect of early entry into care, which goes hand in hand with early ART initiation.
早期抗逆转录病毒疗法（ART）的启动是否会影响性行为风险仍有待记录。我们旨在调查在CD4细胞计数较高的HIV阳性成年人中，早期与标准ART启动后24个月内性行为的变化。
我们使用了一项前瞻性行为研究的数据，该研究嵌套在一项早期ART的随机对照试验（Temprano-ANRS12136）中。使用广义估计方程模型，测量并比较了从试验入组（M0）到12个月（M12）和24个月（M24）访视期间性行为的时间趋势，这些参与者被随机分配为立即启动ART（早期ART）或推迟ART启动直至符合世界卫生组织现行启动标准（标准ART）。性行为指标包括：1）过去一年的性活动；2）过去一年的多个性伴侣；3）最近一次性交时的无保护性行为；4）最近一次性交时的危险性行为（即与HIV阴性/状况不明的伴侣进行无保护性行为）。
分析纳入了1952名参与者（975名接受早期ART，977名接受标准ART；总体基线CD4细胞计数中位数：469/mm³）。在接受早期ART的参与者中，M0至M24期间，性活动（优势比[OR]0.72，95%置信区间[95%CI]0.57 - 0.92）、多个性伴侣（OR 0.57，95%CI 0.41 - 0. .79）、无保护性行为（OR 0.59，95%CI 0.47 - 0.75）和危险性行为（OR 0.58，95%CI 0.45 - 0.76）均显著下降。在接受标准ART的参与者中，性行为随时间呈现相似趋势。这些下降大多发生在两组试验入组后的12个月内，以及接受标准ART的参与者开始ART之前。对于无保护性行为和危险性行为，在报告其最近一次性伴侣为非同居的患者中，下降更为明显或趋于更明显。
在这些撒哈拉以南地区CD4细胞计数较高的成年人中，进入HIV治疗护理，而非启动ART，导致性活动和危险性行为减少。我们没有观察到与早期启动ART相关的风险补偿现象的任何证据。这些结果说明了早期进入护理的潜在行为预防作用，这与早期启动ART相辅相成。
