title: Effect of early antiretroviral therapy on sexual behaviors and HIV-1 transmission risk among adults with diverse heterosexual partnership statuses in Côte d'Ivoire.
abstract: 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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Epidemiology of Occupational and Social Determinants of Health, Center for Research in Epidemiology and Population Health, INSERM U1018.
authors.forename: Kévin
authors.initials: K
authors.lastname: Jean
authors.forename: Delphine
authors.initials: D
authors.lastname: Gabillard
authors.forename: Raoul
authors.initials: R
authors.lastname: Moh
authors.forename: Christine
authors.initials: C
authors.lastname: Danel
authors.forename: Raïmi
authors.initials: R
authors.lastname: Fassassi
authors.forename: Annabel
authors.initials: A
authors.lastname: Desgrées-du-Loû
authors.forename: Serge
authors.initials: S
authors.lastname: Eholié
authors.forename: France
authors.initials: F
authors.lastname: Lert
authors.forename: Xavier
authors.initials: X
authors.lastname: Anglaret
authors.forename: Rosemary
authors.initials: R
authors.lastname: Dray-Spira
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D007560:Cote d'Ivoire / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology / Q000635:transmission* / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D008297:Male; D012307:Risk Factors; D012725:Sexual Behavior / Q000502:physiology / Q000706:statistics & numerical data*
chemical_list: D044966:Anti-Retroviral Agents
keywords: HIV prevention; HIV-1 sexual transmission; antiretroviral treatment; epidemiology; sexual behaviors; sub-Saharan Africa; treatment as prevention