title: The Opposites Attract Study of viral load, HIV treatment and HIV transmission in serodiscordant homosexual male couples: design and methods.
abstract: BACKGROUND
  Studies in heterosexual HIV serodiscordant couples have provided critical evidence on the role of HIV treatments and undetectable viral load in reducing the risk of HIV transmission. There is very limited data on the risk of transmission from anal sex in homosexual male serodiscordant couples.
  
  
  METHODS
  The Opposites Attract Study is an observational prospective longitudinal cohort study of male homosexual serodiscordant partnerships running from 2012 to 2015 and conducted in clinics throughout Australia, Brazil and Thailand. Couples attend two or more clinic visits per year. The HIV-positive partner's viral load is tested and the HIV-negative partner is tested for HIV antibodies at every clinic visit. Results from any tests for sexually transmitted infections are also collected. Detailed behavioural questionnaires are completed by both partners at the time of each visit. The primary research question is whether HIV incidence is lower in those couples where the HIV-positive partner is receiving HIV treatment compared to couples where he is not receiving treatment. A voluntary semen sub-study will examine semen plasma viral load in a subsample of HIV-positive partners in Sydney, Rio de Janeiro and Bangkok. In cases of seroconversion of the initially HIV-negative partner, phylogenetic analysis will be conducted at the end of the study on virus from stored blood samples from both partners to determine if the infection came from the HIV-positive study partner. Men in new serodiscordant relationships will specifically be targeted for recruitment.
  
  
  CONCLUSIONS
  This study will provide critical data on the reduction in HIV transmission risk associated with being on HIV treatment in homosexual male serodiscordant couples in different regions of the world. Data from men in new relationships will be particularly valuable given that the highest transmission risk is in the first year of serodiscordant relationships. Furthermore, the detailed behavioural and attitudinal data from the participant questionnaires will allow exploration of many contextual factors associated with HIV risk, condom use and the negotiation of sexual practice within couples.
authors.affiliation: The Kirby Institute, University of New South Wales, 2052 Sydney, NSW, Australia. bbavinton@kirby.unsw.edu.au.
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Bavinton
authors.forename: Fengyi
authors.initials: F
authors.lastname: Jin
authors.forename: Garrett
authors.initials: G
authors.lastname: Prestage
authors.forename: Iryna
authors.initials: I
authors.lastname: Zablotska
authors.forename: Kersten K
authors.initials: KK
authors.lastname: Koelsch
authors.forename: Nittaya
authors.initials: N
authors.lastname: Phanuphak
authors.forename: Beatriz
authors.initials: B
authors.lastname: Grinsztejn
authors.forename: David A
authors.initials: DA
authors.lastname: Cooper
authors.forename: Christopher
authors.initials: C
authors.lastname: Fairley
authors.forename: Anthony
authors.initials: A
authors.lastname: Kelleher
authors.forename: Kathy
authors.initials: K
authors.lastname: Triffitt
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Grulich
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia; D001938:Brazil; D015483:HIV Antibodies / Q000097:blood; D006679:HIV Seropositivity / Q000188:drug therapy* / Q000635:transmission*; D018451:Homosexuality, Male; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012747:Sexual Partners; D013785:Thailand; D019562:Viral Load; D055815:Young Adult
chemical_list: D015483:HIV Antibodies