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" Susceptibility to transmitting HIV in ART-treated individuals: Longitudinal analysis from Stratall ANRS 12110/ESTHER trial.".
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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, Cameroon 5 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 studywere 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: • Eitherthe 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)
Results (2) Proportion of ICU among patients sexually active during follow-up (n=290)
Results (3) Proportion of patients susceptible to transmitting HIV among those sexually active during follow-up (n=290)
Results (4) Factors associated with susceptibility to transmittingHIV (Mixed logistic regression, N=290 patients, 593 visits)
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.
Acknowledgments Participating 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 Group C. 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. AtemkengFotsop, 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. BilobiFouda, P. EtongMve, 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. MaguipAbanda, 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. MbargaAngo, J. Mbezele, G. Mbong, C. Moung, N. Ekotto, G. NguembaBalla, 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. AmbassaElime, A.A. Bonongnaba, E. Foaleng, R.M. Heles, R. Messina, O. Nana Ndankou, S.A. Ngono, D. NgonoMenounga, 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. MoloBodo, S. NdiNtang, P. Ndoudoumou, L. Ndzomo, S.O. Ngolo, M. Nkengue, Nkoa, Y. Tchinda (District hospital, Sa’a, Cameroon).
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