title: Antiretroviral Therapy Initiation Is Not Associated With Risky Sexual Behavior Among Heterosexual Human Immunodeficiency Virus-Infected Persons in Serodiscordant Partnerships.
abstract: Few prospective studies have assessed whether antiretroviral therapy (ART) use is associated with changes in sexual risk behavior of human immunodeficiency virus (HIV)-infected persons in known HIV-serodiscordant partnerships.
  
  
  
  We conducted a longitudinal analysis of HIV-infected persons with known uninfected partners enrolled in the Partners Pre-Exposure Prophylaxis Study in Kenya and Uganda. Antiretroviral therapy use and self-reported sexual behavior were ascertained every 3 months. We assessed the effect of ART on sexual risk behaviors using zero-inflated negative binomial regression. Primary outcomes were condomless vaginal sex acts, pregnancy incidence and new sexually transmitted infection diagnoses.
  
  
  
  We followed 1817 HIV-infected persons (58% women) for 864 person-years before ART initiation and 771 person-years after ART. Median CD4 and plasma viral load at ART initiation were 277 cells/μL and 4.18 log10 copies/mL. Antiretroviral therapy use was associated with a significant decrease in condomless vaginal sex acts with HIV-uninfected partners (0.65 vs 0.39 per month; rate ratio, 0.64; 95% confidence interval [CI], 0.55-0.75; P < 0.001), but not condomless vaginal sex acts with nonprimary partners (1.30 vs 1.04 per month; rate ratio, 0.94; 95% CI, 0.94-1.20; P = 0.62). Pregnancy incidence was lower after ART (13.2 vs 8.4 per 100 person-years; HR, 0.71; 95% CI, 0.60-0.84; P < 0.001). Incident sexually transmitted infection diagnoses were similar (odds ratio, 1.05; 95% CI, 0.86-1.29; P = 0.63).
  
  
  
  Substantial risk compensation did not occur after ART initiation among East African HIV-infected persons with known HIV-uninfected partners. These data inform modelling studies of ART for HIV prevention by suggesting that risky sexual behavior did not appear to offset decreased HIV infectiousness in this key population.
authors.affiliation: From the Departments of *Global Health; †Epidemiology; ‡Medicine, University of Washington, Seattle, WA; §School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Kenya; and ¶Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
authors.forename: Andrew
authors.initials: A
authors.lastname: Mujugira
authors.forename: Connie
authors.initials: C
authors.lastname: Celum
authors.forename: Kenneth
authors.initials: K
authors.lastname: Ngure
authors.forename: Katherine K
authors.initials: KK
authors.lastname: Thomas
authors.forename: Elly
authors.initials: E
authors.lastname: Katabira
authors.forename: Jared M
authors.initials: JM
authors.lastname: Baeten
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000523:psychology*; D018023:HIV Seronegativity; D020010:Heterosexuality / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D007630:Kenya; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D065129:Pre-Exposure Prophylaxis / Q000379:methods / Q000706:statistics & numerical data*; D012309:Risk-Taking; D012725:Sexual Behavior / Q000523:psychology*; D014454:Uganda
chemical_list: D019380:Anti-HIV Agents