" susceptibility to transmitting hiv in art- treated individuals: longitudinal analysis from...
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"Susceptibility to transmitting HIV in
ART-treated individuals: Longitudinal analysis from Stratall ANRS 12110/ESTHER trial."
Julien COHEN1,2,3, Sylvie BOYER1,2,3, Charles KOUANFACK4, Maria Patrizia CARRIERI1,2,3, Gilbert NDZIESSI1,2,3, Camélia PROTOPOPESCU1,2,3, Jean-Paul MOATTI1,2,3, Eric DELAPORTE5,6, Christian LAURENT5,6, Bruno SPIRE1,2,3
and the Stratall ANRS 12110/ESTHER Study Group
1 INSERM, U912 (SE4S), Marseille, France 2 Université Aix Marseille, IRD, UMR-S912, Marseille, France 3 ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d’Azur, Marseille, France 4 Central Hospital, Yaoundé, Cameroon5 Institut de Recherche pour le Développement (IRD), University Montpellier 1, UMR 145, Montpellier, France 6 Department of Infectious and Tropical Diseases, University Hospital, Montpellier, France
Background (1)
ART preventive intervention for reducing sexual HIV
transmission:
High efficacy of antiretroviral therapy for vertical
transmission
A 92% reduction in transmission among 3381 ART-
treated heterosexual African couples Donnel, 2010
HPTN 052 trial: Immediate ART initiation reduced
HIV-infection in sexual partners by 96% compared
with ART initiation following WHO guidelines.
Background (2)
Reduction of HIV transmission by ART
Behavioral disinhibition concerning condom use?
Longitudinal data from the ANRS STRATALL study
were used to explore :
the course of sexual risk of HIV-transmission
during the first 24 months of treatment in ART
naïve HIV-infected adults
the characteristics of viremic ART-treated PLWHA
who do not consistently use condoms
Methods (1)
Stratall ANRS 12110/ESTHER :
24-month, randomized, open-label trial
Enrolled 459 HIV-infected adults followed-up in
rural district hospitals in Cameroon
Primary objective : to compare the increase in
CD4 cell counts in two groups using:
Either the recommended WHO “public health”
approach for low-income countries
Or the standard approach used in developed countries
Methods (2)
Plasma viral load measured during clinical
visits at M0, M6, M12, M18 and M24.
Psychosocial data (including sexual
behaviors and healthcare staff’s readiness
to listen) collected using face-to-face
questionnaires administered at M0, M6,
M12 and M24
Methods (4)
Stable virological success (SVS) : having
an undetectable viral load (<40 copies/ml)
for more than 6 months.
Inconsistent condom use (ICU): Not using
condoms with HIV-negative partners or
those with unknown serostatus at least
once in the three months prior to the visit
Susceptibility to transmitting HIV was
defined as: lack of SVS + ICU
Methods (5)
McNemar tests were performed to
assess changes in ICU and susceptibility
to transmitting HIV during follow-up
A mixed logistic regression model was
used to identify correlates of
susceptibility to transmitting HIV
Results (1)
Proportion of patients with detectable viral load
among patients sexually active during follow-up
(n=290)
M6 M12 M240
20
40
60
80
100
37 % 36 % 32 %
Results (2)
Proportion of ICU among patients sexually
active during follow-up (n=290)
M0 M6 M12 M240
102030405060708090
100
64 %
40 %47 %
55 %
Results (3)
Proportion of patients susceptible to
transmitting HIV among those sexually active
during follow-up (n=290)
M0 M6 M12 M240
20
40
60
80
100
64 %
23 % 26 % 22 %
Results (4)
Factors associated with susceptibility to transmitting HIV(Mixed logistic regression, N=290 patients, 593 visits)AOR [95% CI] P-value
Time since ART initiation- M0 (ref)- M6- M12- M24
0.14 [0.07-0.30]0.16 [0.08-0.33]0.11 [0.05-0.24]
<10-3
<10-3
<10-3
More than one sexual relationship per week
2.01 [1.00-4.03] 0.05
More than one sexual partner
2.44 [1.12-5.34] 0.03
Limited readiness by health staff to listen
1.81 [1.00-3.27] 0.05
Conclusion
Despite an increase in ICU, the
proportion of individuals susceptible to
transmitting HIV decreased and
remained low.
Fear of behavioral disinhibition should
not be a barrier to universal access to
treatment.
Reinforcing healthcare staff’s
counseling skills may be crucial for
positive prevention.
AcknowledgmentsParticipating patients & hospital teams
Sponsorship:- French National Agency for Research on AIDS and viral hepatitis (ANRS)-French Public Interest Group ESTHER-SIDACTION
The Stratall ANRS 12110/ESTHER trial Study GroupC. Kouanfack, S. Koulla-Shiro (Central hospital, Yaoundé, Cameroon); A. Bourgeois, E. Delaporte, C. Laurent (IRD, University Montpellier 1, UMR 145, Montpellier, France); G. Laborde-Balen (French Ministry of Foreign Affairs, Yaoundé, Cameroon); T. Atemkeng Fotsop, M. Dontsop, S. Kazé, J-M. Mben, M-A. Ngo Hamga, Z. Tsomo (IRD, Yaoundé, Cameroon); A. Aghokeng, M.G. Edoul, E. Mpoudi-Ngolé, M. Tongo (Virology Laboratory, IMPM/CREMER/IRD-UMR 145, Yaoundé, Cameroon); J. Blanche, S. Boyer, M.P. Carrieri, J. Cohen, S. Loubière, M. Meresse, F. Marcellin, J-P. Moatti, B. Spire (INSERM, IRD, University Aix Marseille, UMR 912, Marseille, France); C. Abé, S-C. Abega, C-R. Bonono, H. Mimcheu, S. Ngo Yebga, C. Paul Bile (IRSA, Catholic University of Central Africa, Yaoundé, Cameroon); S. Abada, T. Abanda, J. Baga, P. Bilobi Fouda, P. Etong Mve, G. Fetse Tama, H. Kemo, A. Ongodo, V. Tadewa, HD. Voundi (District Hospital, Ayos, Cameroon); A. Ambani, M. Atangana, J-C. Biaback, M. Kennedy, H. Kibedou, F. Kounga, M. Maguip Abanda, E. Mamang, A. Mikone, S. Tang, E. Tchuangue, S. Tchuenko, D. Yakan (District Hospital, Bafia, Cameroon); J. Assandje, S. Ebana, D. Ebo’o, D. Etoundi, G. Ngama, P. Mbarga Ango, J. Mbezele, G. Mbong, C. Moung, N. Ekotto, G. Nguemba Balla, G. Ottou, M. Tigougmo (District Hospital, Mbalmayo, Cameroon); R. Beyala, B. Ebene, C. Effemba, F. Eyebe, M-M. Hadjaratou, T. Mbarga, M. Metou, M. Ndam, B. Ngoa, EB. Ngock, N. Obam (District hospital, Mfou, Cameroon); A. M. Abomo, G. Angoula, E. Ekassi, Essama, J.J. Lentchou, I. Mvilongo, J. Ngapou, F. Ntokombo, V. Ondoua, R. Palawo, S. Sebe, E. Sinou, D. Wankam, I. Zobo (District hospital, Monatélé, Cameroon); B. Akono, A. L. Ambani, L. Bilock, R. Bilo’o, J. Boombhi, F.X. Fouda, M. Guitonga, R. Mad’aa, D.R. Metou’ou, S. Mgbih, A. Noah, M. Tadena, Ntcham (District hospital, Nanga Eboko, Cameroon); G. Ambassa Elime, A.A. Bonongnaba, E. Foaleng, R.M. Heles, R. Messina, O. Nana Ndankou, S.A. Ngono, D. Ngono Menounga, S.S. Sil, L. Tchouamou, B. Zambou (District hospital, Ndikinimeki, Cameroon); R. Abomo, J. Ambomo, C. Beyomo, P. Eloundou, C. Ewole, J. Fokom, M. Mvoto, M. Ngadena, R. Nyolo, C. Onana, A. Oyie (District hospital, Obala, Cameroon); P. Antyimi, S. Bella Mbatonga, M. Bikomo, Y. Molo Bodo, S. Ndi Ntang, P. Ndoudoumou, L. Ndzomo, S.O. Ngolo, M. Nkengue, Nkoa, Y. Tchinda (District hospital, Sa’a, Cameroon).
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