在治疗即预防时代，与HIV血清学不一致的固定性伴侣发生性行为且病毒得到抑制的HIV感染女性中的无保护性行为

Condomless Sex Among Virally Suppressed Women With HIV With Regular HIV-Serodiscordant Sexual Partners in the Era of Treatment as Prevention.

作者信息

Patterson Sophie, Carter Allison, Nicholson Valerie, Webster Kath, Ding Erin, Kestler Mary, Ogilvie Gina, de Pokomandy Alexandra, Loutfy Mona, Kaida Angela

机构信息

*Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada;†Department of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada;‡Oak Tree Clinic, British Columbia Women's Hospital and Healthcare Centre, Vancouver, British Columbia, Canada;§Department of Medicine, Division of Infectious Diseases, University of British Columbia, Vancouver, British Columbia, Canada;‖Chronic Viral Illness Service, McGill University Health Centre, Montreal, Québec, Canada;¶Department of Family Medicine, McGill University, Montreal, Québec, Canada;#Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; and**Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

出版信息

J Acquir Immune Defic Syndr. 2017 Dec 1;76(4):372-381. doi: 10.1097/QAI.0000000000001528.

DOI:10.1097/QAI.0000000000001528

PMID:29077673

Abstract

BACKGROUND

Sexual HIV transmission does not occur with sustained undetectable viral load (VL) on antiretroviral therapy (ART). Awareness of ART prevention benefits and its influence on condom use among women with HIV (WWH) remain unexplored. We estimated prevalence and correlates of condomless sex with regular HIV-serodiscordant partners among WWH with undetectable VL on ART.

METHODS

We used baseline questionnaire data from the community-based longitudinal Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS). We included WWH self-reporting vaginal/anal sex with ≥1 HIV-negative/unknown status regular partner within 6 months, and undetectable VL (<50 copies/mL) on ART. We excluded participants exclusively reporting female partners or missing condom-use data. Condomless sex was defined as <100% condom use within 6 months. The primary explanatory variable was awareness of ART prevention benefits. Logistic regression identified factors independently associated with condomless sex.

RESULTS

Of 271 participants (19% of the CHIWOS cohort), median age was 41 (interquartile range: 34-47), 51% were in a relationship, 55% reported condomless sex, and 75% were aware of ART prevention benefits. Among women aware, 63% reported condomless sex compared with 32% of women not aware (P < 0.001). Factors independently associated with condomless sex included being aware of ART prevention benefits (adjusted odds ratio: 4.08; 95% confidence interval: 2.04 to 8.16), white ethnicity, ≥high-school education, residing in British Columbia, and being in a relationship.

CONCLUSIONS

Virally suppressed women aware of ART prevention benefits had 4-fold greater odds of condomless sex. Advancing safer sex discussions beyond condoms is critical to support women in regular serodiscordant partnerships to realize options for safe and satisfying sexuality in the Treatment-as-Prevention era.

摘要

背景

接受抗逆转录病毒治疗（ART）时，若病毒载量（VL）持续检测不到，则不会发生性传播HIV。ART预防益处的知晓情况及其对感染HIV女性（WWH）使用避孕套的影响仍未得到研究。我们估计了接受ART且VL检测不到的WWH中与HIV血清学不一致的固定性伴侣发生无保护性行为的患病率及其相关因素。

方法

我们使用了基于社区的加拿大HIV女性性与生殖健康队列研究（CHIWOS）的基线问卷调查数据。我们纳入了在6个月内与≥1名HIV阴性/状况不明的固定伴侣有过阴道/肛交自我报告，且接受ART时VL检测不到（<50拷贝/毫升）的WWH。我们排除了仅报告女性伴侣或缺失避孕套使用数据的参与者。无保护性行为定义为6个月内避孕套使用率<100%。主要解释变量是对ART预防益处的知晓情况。逻辑回归确定了与无保护性行为独立相关的因素。

结果

在271名参与者中（占CHIWOS队列的19%），中位年龄为41岁（四分位间距：34 - 47岁），51%处于恋爱关系中，55%报告有过无保护性行为，75%知晓ART预防益处。在知晓的女性中，63%报告有过无保护性行为，而不知晓的女性中这一比例为32%（P<0.001）。与无保护性行为独立相关的因素包括知晓ART预防益处（调整后的优势比：4.08；95%置信区间：2.04至8.16）、白人种族、高中及以上学历、居住在不列颠哥伦比亚省以及处于恋爱关系中。