North Manchester General Hospital: Ed Wilkins; Yvonne Clowes;. Jennifer Cullie; Cynthia Murphy; Christina Martin; Valerie. George; Andrew Thompson.
ART use, viral suppression, and sexual behaviour among HIV-diagnosed MSM in the UK: results from the ASTRA (Antiretrovirals, Sexual Transmission Risk and Attitudes) Study
Acknowledgments: All ASTRA study participants ASTRA clinic teams: Mortimer Market Centre: Richard Gilson; Simon Edwards; Lewis Haddow; Simon Gilson; Christina Broussard; Robert Pralat Royal Free Hospital: Alison Rodger; Margaret Johnson; Jeff McDonnell; Adebiyi Aderonke Brighton and Sussex University Hospital: Martin Fisher; Nicky Perry; Alex Pollard; Serge Fedele; Louise Kerr; Lisa Heald; Wendy Hadley; Kerry Hobbs; Julia Williams; Elaney Youssef; Celia Richardson; Sean Groth North Manchester General Hospital: Ed Wilkins; Yvonne Clowes; Jennifer Cullie; Cynthia Murphy; Christina Martin; Valerie George; Andrew Thompson Homerton University Hospital: Jane Anderson; Sifiso Mguni; Damilola Awosika; Rosalind Scourse East Sussex Sexual Health Clinic: Kazeem Aderogba; Caron Osborne; Sue Cross; Jacqueline Whinney; Martin Jones Newham University Hospital: Rebecca O’Connell, Cheryl Tawana Whipps Cross University Hospital: Monica Lascar, Zandile Maseko
Lampe FC1, Speakman A1, Phillips AN1, Sherr L1, Gilson R1, Johnson MA2, Fisher M3, Wilkins E4, Anderson J5, Edwards S1, McDonnell J1, Perry N3, Aderogba K6, Hart G1, Johnson A1, Collins S7, Elford J8, Miners A9, Geretti AM10, Burman B11, Rodger A1, for the ASTRA Study Group. 1University
College London, London, UK; 2Royal Free Hampstead NHS Trust, London, UK; 3Brighton and Sussex University Hospitals NHS Trust, Brighton, UK; 4Pennine Acute Hospitals NHS Trust, Manchester, UK; 5Homerton University Hospital, London, UK; 6East Sussex Healthcare NHS Trust; 7HIV i-Base, London, UK; 8City University, London, UK; 9London School of Hygiene and Tropical Medicine, London, UK; 10University of Liverpool, Liverpool, UK; 11University of Colorado, Colorado, USA.
Background
Methods
New diagnoses of HIV are increasing among MSM in the UK. A policy of starting antiretroviral treatment (ART) early may help to reduce HIV transmission. However it is uncertain whether ART use may be associated with lower levels of condom use among people diagnosed with HIV. We aimed to assess, among HIV-diagnosed MSM in the ASTRA (Antiretrovirals, Sexual Transmission Risk and Attitudes) Study:
ASTRA currently includes 3011 HIV-outpatients recruited in 2011/12 from 6 UK centres in London, Manchester, Brighton and Eastbourne. (Response rate: 3011/4741; 64%). 2182 MSM are included in this analysis. A self-completed questionnaire ascertained:
1) 2) 3) 4)
Prevalence of recent condom-less sex with an HIV-discordant partner Association of ART use and self-reported viral load (VL) status with condom-less sex with an HIV-discordant partner Beliefs about undetectable VL and HIV transmission risk The association of other factors (demographic, socio-economic, health, lifestyle) with condom-less sex with an HIV-discordant partner
• Current and previous ART use • Self-reported VL level at most recent test (‘≤50c/mL or undetectable’; ‘>50c/mL or detectable’; ‘don’t know’) • Condom-less anal or vaginal sex with an HIV discordant (negative or unknown) status partner in the past three months (CLS-D) • Total number of new sexual partners in the past year • Transmission risk belief score (TRBS) • Other demographic, socio-economic, health, lifestyle, and HIV-related factors
Table 1. Sexual lifestyle among MSM in ASTRA N1
n
Prevalence (95% CI)
Any anal or vaginal sex
2169
1394
64.3% (62.3, 66.3)
Condom-less anal or vaginal sex
2165
835
38.6% (36.5, 40.6)
Condom-less anal or vaginal sex with HIVdiscordant partner (CLS-D)
2097
324
15.5% (13.9, 17.0)
FOR 324 MSM REPORTING CLS-D ONLY With long-term partner only With long-term partner and other partner(s) With other partner(s) only
324
N=2182 MSM
1 CLS-D partner 2-4 CLS-D partners ≥5 CLS-D partners
176 106 44
54.3% 32.7% 13.0%
Vaginal sex Insertive anal sex with ejaculation Insertive anal sex, without ejaculation Receptive anal sex only
12 98 95 119
3.7% 30.2% 29.3% 36.7%
Table 2: Association of ART, self-reported VL, TRBS, and other factors, with condom-less sex with discordant partner (CLS-D): MSM Total N (%) % with CLS-D1 P-value2 ART classification (A) [N=2155]
On ART Off ART
1830 (84.9) 325 (15.1)
20.8% 14.4%
p=0.004
ART classification (B) [N=2155]
Never taken ART Stopped ART On ART
287 (13.3) 38 (1.8) 1830 (84.9)
19.3% 31.6% 14.4%
p=0.002
ART classification (C) [N=2155]
Off ART On ART with undetectable VL On ART, without undetectable VL$
325 (15.1) 1518 (70.4) 312 (14.5)
20.8% 15.4% 9.4%
p=0.001
TRBS (transmission risk belief) score [N=2142]
2 (condom not necessary if VL undetectable) 1 (undetectable VL means person less infectious) 0 (do not agree with either of above)
121 (5.6) 998 (46.6) 1023 (47.8)
32.7% 20.2% 8.6%
p20
58 (2.7) 179 (8.3) 331 (15.4) 529 (24.6) 438 (20.4) 358 (16.6) 259 (12.0)
23.2 14.4 19.3 17.3 14.9 12.9 10.0
p=0.020
