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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
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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.
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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
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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
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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
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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
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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
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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 %
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Results (2)
Proportion of ICU among patients sexually
active during follow-up (n=290)
M0 M6 M12 M240
102030405060708090
100
64 %
40 %47 %
55 %
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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 %
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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
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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.
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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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THE ITALIAN GOVERNMENT STILL OWES 260 MILLION EUROS TO THE GLOBAL FUND AND
NEVER PLEDGED FOR 2011 - 2013
ITALY:KEEP THE PROMISE, NOW!
FUND THE FUND, NOW! AIDS, TUBERCOLOSIS AND MALARIA WILL NOT WAIT!