Effects of HIV Antiretroviral Therapy on Sexual and Injecting Risk-Taking Behavior: A Systematic Review and Meta-analysis

Doyle, Joseph S; Degenhardt, Louisa; Pedrana, Alisa; McBryde, Emma S.; Guy, Rebecca; Stoové, Mark; Weaver, Emma R; Grulich, Andrew E.; Lo, Ying-Ru; Hellard, Margaret

doi:10.1093/cid/ciu602

Cited by 36 publications

(29 citation statements)

References 106 publications

(79 reference statements)

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“…STI prevalence was greatest at the time of HIV diagnosis, and the prevalence of STIs among people receiving ART (16.2%, SD 23.7) was not appreciably different compared to HIV-infected persons not yet on ART (16.5% SD 13.3; p=0.09). A more recent meta-analysis of 55 studies on the effect of ART on sexual risk behaviors and STIs found that sexual risk taking was lower among those receiving ART compared with those not on ART (OR=0.7; 95% CI=0.62–0.81) and that incidence of STIs was also lower among those on ART (OR=0.38; 95%CI=0.33–1.01) [10]. …”

Section: Introductionmentioning

confidence: 99%

High burden of STIs among HIV-infected adults prior to initiation of ART in South Africa: a retrospective cohort study

et al. 2014

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Objectives To assess the burden of STIs among HIV-positive South Africans in the period prior to ART initiation compared to the period once on ART. Methods We linked the clinic records of 1,465 patients currently on ART to the electronic database which records all visits to City clinics. We used a mixed effects Poisson model to assess the relative rates of occurrence of treatment seeking for an STI in the periods prior to initiation of ART and while on ART. Results We accumulated 4,214 person-years of follow-up, divided nearly equally between the pre-ART and on ART periods. The rate of treatment seeking for new STIs was 5.50 (95% CI 5.43–5.78) per 100 person-years, and individuals had on average a seven-fold higher rate of seeking treatment for STIs in the period prior to initiating ART (9.57 per 100 person-years) compared to the period once on ART (5.5 per 100 person-years) (adjusted rate ratio [RR] 7.01, 95% CI 4.64–10.59). Being male (RR 1.73, 95% CI 1.18–2.55) or younger (

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Section: Introductionmentioning

confidence: 99%

High burden of STIs among HIV-infected adults prior to initiation of ART in South Africa: a retrospective cohort study

et al. 2014

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“…ART use was associated with a reduction in unprotected sex (OR 0.55; 95% CI: 0.30–0.99; p<0.001) but heterogeneity was significant (I 2 =85.2%). In another meta-analysis (9), ART use was associated with decreased unprotected sex with HIV-uninfected or unknown status partners (OR 0.64: 95% CI: 0.46–0.88, p<0.001; heterogeneity I 2 =61%). Condomless sex decreases after ART initiation in most populations (9), but some sub-populations experience increased condomless sex over time (25, 26).…”

Section: Discussionmentioning

confidence: 98%

“…In another meta-analysis (9), ART use was associated with decreased unprotected sex with HIV-uninfected or unknown status partners (OR 0.64: 95% CI: 0.46–0.88, p<0.001; heterogeneity I 2 =61%). Condomless sex decreases after ART initiation in most populations (9), but some sub-populations experience increased condomless sex over time (25, 26). A study from Uganda reported decreased sexual risk behavior in women (OR 0.85 per year of ART) but not men (OR 1.41 per year of ART) (23).…”

Section: Discussionmentioning

confidence: 98%

“…Prior studies of unprotected sex with serodiscordant or unknown status partners were cross-sectional and compared HIV-infected persons taking ART versus not, limited by small sample sizes, or had short duration of follow-up limiting assessment of the durable effect of ART on sexual risk behavior (9). We aimed to assess whether ART use is associated with increased frequency of high-risk sexual behavior in a large prospective study of HIV-serodiscordant couples in which the HIV-infected partner initiated ART.…”

Section: Introductionmentioning

confidence: 99%

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Antiretroviral Therapy Initiation Is Not Associated With Risky Sexual Behavior Among Heterosexual Human Immunodeficiency Virus–Infected Persons in Serodiscordant Partnerships

Mujugira¹,

Celum²,

Ngure

et al. 2017

Sexual Trans Dis

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Background Few prospective studies have assessed whether antiretroviral therapy (ART) use is associated with changes in sexual risk behavior of HIV-infected persons in known HIV-serodiscordant partnerships. Methods We conducted a longitudinal analysis of HIV-infected persons with known uninfected partners enrolled in the Partners PrEP Study in Kenya and Uganda. ART use and self-reported sexual behavior were ascertained every 3 months. We assessed the effect of ART on sexual risk behaviors using zero-inflated negative binomial regression. Primary outcomes were condomless vaginal sex acts, pregnancy incidence and new STI diagnoses. Results We followed 1817 HIV-infected persons (58% women) for 864 person-years before ART initiation and 771 person-years after ART. Median CD4 and plasma viral load at ART initiation were 277 cells/μL and 4.18 log10 copies/mL. ART use was associated with a significant decrease in condomless vaginal sex acts with HIV-uninfected partners (0.65 vs. 0.39 per month; rate ratio [RR] 0.64; 95% CI: 0.55–0.75; p<0.001), but not condomless vaginal sex acts with non-primary partners (1.30 vs. 1.04 per month; RR 0.94; 95% CI: 0.94–1.20; p=0.62). Pregnancy incidence was lower after ART (13.2 vs 8.4 per 100 person-years; HR 0.71, 95% CI: 0.60–0.84, p<0.001). Incident STI diagnoses were similar (OR 1.05, 95% CI: 0.86–1.29; p=0.63). Conclusions Substantial risk compensation did not occur following ART initiation among East African HIV-infected persons with known HIV-uninfected partners. These data inform modeling studies of ART for HIV prevention by suggesting that risky sexual behavior did not appear to offset decreased HIV infectiousness in this key population.

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“…In a meta-analysis of 60 studies, injecting risk-taking (measured by sharing needles/syringes) and sexual risk-taking (measured by inconsistent condom use and new sexually transmitted infection diagnoses) were not associated with commencement of HIV antiretroviral therapy [53]. Moreover, among those individuals on therapy, sexual risk-taking was marginally lower, reflecting that individuals commencing long-term therapy are probably self-selecting and lower risk-takers than those not undertaking therapy.…”

Section: Insights From Human Immunodeficiency Virus (Hiv) Infection -mentioning

confidence: 99%

Global policy and access to new hepatitis C therapies for people who inject drugs

Doyle

Aspinall

Hutchinson

et al. 2015

International Journal of Drug Policy

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People who inject drugs (PWID) are disproportionately affected by hepatitis C virus (HCV). This review outlines policy recommendations made in the 2014 World Health Organisation (WHO) Guidelines on Screening, Care and Treatment of HCV and their relevance to PWID. It also canvasses issues that will affect translation of these global guidelines into practice. The first global HCV guidelines released by WHO have recently advocated targeted HCV testing for PWID, assessment of liver disease and support for alcohol reduction during care. They also strongly advocate treatment using currently licensed direct-acting antiviral agents for all individuals, in particular PWID as a key affected population. New HCV treatment regimens have the potential to cure more than 90% of treated individuals. Scaling-up treatment among PWID has the potential to improve individual and population health by reducing HCV transmission, improving quality of life and supporting behaviour modifications that lead to less risk-taking over time. PWID face several barriers to accessing HCV care and treatment that need to be overcome. Testing services need re-orientation toward PWID, individuals need to be informed of their results and provided with direct linkage to ongoing care. Health services need to provide care in the community using simpler, cheaper and more accessible modes of delivery. Healthcare costs and pharmaceutical costs need to be minimised so PWID, who are highly marginalised, can access HCV treatment. Sustained scale-up of treatment for PWID could simultaneously improve individual health and achieve the goal of eliminating HCV transmission among this high-risk and vulnerable group.

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Effects of HIV Antiretroviral Therapy on Sexual and Injecting Risk-Taking Behavior: A Systematic Review and Meta-analysis

Cited by 36 publications

References 106 publications

High burden of STIs among HIV-infected adults prior to initiation of ART in South Africa: a retrospective cohort study

High burden of STIs among HIV-infected adults prior to initiation of ART in South Africa: a retrospective cohort study

Antiretroviral Therapy Initiation Is Not Associated With Risky Sexual Behavior Among Heterosexual Human Immunodeficiency Virus–Infected Persons in Serodiscordant Partnerships

Global policy and access to new hepatitis C therapies for people who inject drugs

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