%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES
%A Jean, K.
%A Gabillard, D.
%A Moh, R.
%A Danel, C.
%A Fassassi, R.
%A Desgrées du Loû, Annabel
%A Eholie, S.
%A Lert, F.
%A Anglaret, X.
%A Dray-Spira, R.
%T Effect of early antiretroviral therapy on sexual behaviors and HIV-1 transmission risk among adults with diverse heterosexual partnership statuses in Cote d'Ivoire
%D 2014
%L fdi:010061487
%G ENG
%J Journal of Infectious Diseases
%@ 0022-1899
%K HIV prevention ; antiretroviral treatment ; sexual behaviors ; HIV-1 sexual ; transmission ; treatment as prevention ; epidemiology ; sub-Saharan Africa
%K COTE D'IVOIRE
%M ISI:000329921700018
%N 3
%P 431-440
%R 10.1093/infdis/jit470
%U https://www.documentation.ird.fr/hor/fdi:010061487
%> https://www.documentation.ird.fr/intranet/publi/2014/02/010061487.pdf
%V 209
%W Horizon (IRD)
%X Background. The effect of early initiation of antiretroviral therapy (ART; ie, at CD4(+) T-cell counts >350 cells/mm(3)) on sexual behaviors and human immunodeficiency virus type 1 (HIV) transmission risk has not been documented in populations other than HIV-serodiscordant couples in stable relationships. Methods. On the basis of data from a behavioral study nested in a randomized, controlled trial (Temprano-ANRS12136) of early ART, we compared proportions of risky sex (ie, unprotected sex with a partner of negative/unknown HIV status) reported 12 months after inclusion between participants randomly assigned to initiate ART immediately (hereafter, "early ART") or according to ongoing World Health Organization criteria. Group-specific HIV transmission rates were estimated on the basis of sexual behaviors and viral load-specific per-act HIV transmission probabilities. The ratio of transmission rates was computed to estimate the protective effect of early ART. Results. Among 957 participants (baseline median CD4(+) T-cell count, 478 cells/mm(3)), 46.0% reported sexual activity in the past month; of these 46.0%, sexual activity for 41.5% involved noncohabiting partners. The proportion of subjects who engaged in risky sex was 10.0% in the early ART group, compared with 12.8% in the standard ART group (P = .17). After accounting for sexual behaviors and viral load, we estimated that the protective effect of early ART was 90% (95% confidence interval, 81%-95%). Conclusion. Twelve months after inclusion, patients in the early and standard ART groups reported similar sexual behaviors. Early ART decreased the estimated risk of HIV transmission by 90%, suggesting a major prevention benefit among seronegative sex partners in stable or casual relationships with seropositive individuals.
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