title: Decrease in sexual risk behaviours after early initiation of antiretroviral therapy: a 24-month prospective study in Côte d'Ivoire.
abstract: BACKGROUND
  Whether early antiretroviral therapy (ART) initiation could impact sexual risk behaviours remains to be documented. We aimed to investigate changes in sexual behaviours within the 24 months following an early versus standard ART initiation in HIV-positive adults with high CD4 counts.
  
  
  METHODS
  We used data from a prospective behavioural study nested in a randomized controlled trial of early ART (Temprano-ANRS12136). Time trends in sexual behaviours from enrolment in the trial (M0) to 12-month (M12) and 24-month (M24) visits were measured and compared, using Generalized Estimating Equations models, between participants randomly assigned either to initiate ART immediately (early ART) or to defer ART initiation until on-going WHO starting criteria are met (standard ART). Indicators of sexual behaviours included 1) sexual activity in the past year, 2) multiple partnership in the past year, 3) unprotected sex at last intercourse and 4) risky sex (i.e. unprotected sex with a partner of HIV negative/unknown status) at last intercourse.
  
  
  RESULTS
  Analyses included 1952 participants (975 with early ART and 977 with standard ART; overall median baseline CD4 count: 469/mm(3)). Among participants with early ART, significant decreases were found between M0 and M24 in sexual activity (Odds Ratio [OR] 0.72, 95% Confidence Interval [95% CI] 0.57-0.92), multiple partnership (OR 0.57, 95% CI 0.41-0.79), unprotected sex (OR 0.59, 95% CI 0.47-0.75) and risky sex (OR 0.58, 95% CI 0.45-0.76). Among participants with standard ART, sexual behaviours showed similar trends over time. These decreases mostly occurred within the 12 months following enrolment in the trial in both groups and prior to ART initiation in participants with standard ART. For unprotected sex and risky sex, decreases were or tended to be more pronounced among patients reporting that their last sexual partner was non-cohabiting.
  
  
  CONCLUSIONS
  In these sub-Saharan adults with high CD4 counts, entry into HIV care, rather than ART initiation, resulted in decreased sexual activity and risky sexual behaviours. We did not observe any evidence of a risk compensation phenomenon associated with early ART initiation. These results illustrate the potential behavioural preventive effect of early entry into care, which goes hand in hand with early ART initiation.
authors.affiliation: Epidemiology of Occupational and Social Determinants of Health - Center for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France; UMRS 1018, Université Versailles Saint-Quentin, Villejuif, France; kevin.jean@inserm.fr.
authors.forename: Kévin
authors.initials: K
authors.lastname: Jean
authors.affiliation: PAC-CI Program, CHU de Treichville, Abidjan, Côte d'Ivoire; INSERM U897, Université Bordeaux Segalen, Bordeaux, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Gabillard
authors.affiliation: PAC-CI Program, CHU de Treichville, Abidjan, Côte d'Ivoire; INSERM U897, Université Bordeaux Segalen, Bordeaux, France.
authors.forename: Raoul
authors.initials: R
authors.lastname: Moh
authors.affiliation: PAC-CI Program, CHU de Treichville, Abidjan, Côte d'Ivoire; INSERM U897, Université Bordeaux Segalen, Bordeaux, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Danel
authors.affiliation: CEPED (Population and Development Research Center - UMR 196 - Paris Descartes/INED/IRD), IRD (Institut de Recherche pour le Développement), Paris, France.
authors.forename: Annabel
authors.initials: A
authors.lastname: Desgrées-du-Loû
authors.affiliation: PAC-CI Program, CHU de Treichville, Abidjan, Côte d'Ivoire; INSERM U897, Université Bordeaux Segalen, Bordeaux, France.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: N'takpe
authors.affiliation: PAC-CI Program, CHU de Treichville, Abidjan, Côte d'Ivoire; INSERM U897, Université Bordeaux Segalen, Bordeaux, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Le Carrou
authors.affiliation: PAC-CI Program, CHU de Treichville, Abidjan, Côte d'Ivoire; INSERM U897, Université Bordeaux Segalen, Bordeaux, France.
authors.forename: Anani
authors.initials: A
authors.lastname: Badjé
authors.affiliation: PAC-CI Program, CHU de Treichville, Abidjan, Côte d'Ivoire; Service des Maladies Infectieuses et Tropicales, CHU de Treichville, Abidjan, Côte d'Ivoire.
authors.forename: Serge
authors.initials: S
authors.lastname: Eholié
authors.affiliation: Epidemiology of Occupational and Social Determinants of Health - Center for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France; UMRS 1018, Université Versailles Saint-Quentin, Villejuif, France.
authors.forename: France
authors.initials: F
authors.lastname: Lert
authors.affiliation: PAC-CI Program, CHU de Treichville, Abidjan, Côte d'Ivoire; INSERM U897, Université Bordeaux Segalen, Bordeaux, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Anglaret
authors.affiliation: Epidemiology of Occupational and Social Determinants of Health - Center for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France; UMRS 1018, Université Versailles Saint-Quentin, Villejuif, France.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Dray-Spira
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007560:Cote d'Ivoire / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012725:Sexual Behavior / Q000523:psychology / Q000706:statistics & numerical data; D013997:Time Factors; D047568:Unsafe Sex / Q000523:psychology / Q000706:statistics & numerical data*
chemical_list: D019380:Anti-HIV Agents
keywords: AIDS; HIV; HIV prevention; antiretroviral treatment; early ART initiation; sexual behaviours; sub-Saharan Africa