AEGiS-13IAC: Recent increase in sexual risk behavior and sexually transmitted diseases in a cohort of homosexual men: the price of highly active anti-retroviral therapy?

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Recent increase in sexual risk behavior and sexually transmitted diseases in a cohort of homosexual men: the price of highly active anti-retroviral therapy?

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. ThOrC715)

Dukers N, de Wit J, Goudsmit J, Coutinho R
N. Dukers, Municipal Health Service Amsterdam, Nieuwe Achtergracht 100, 1018 WT, Amsterdam, Netherlands, Tel.: +31 20 555 5524, Fax: +31 20 555 5533, E-mail: ndukers@gggd.amsterdam.nl

BACKGROUND: The positive effect of highly active anti-retroviral therapy (HAART) may result in a relapse in sexual risk behavior, increasing the spread of HIV and other sexually transmitted diseases (STD's). We examined among homosexual men (HM) 1) trends in sexual behavior and STD's before and after the introduction of HAART (July 1996) and 2) the risk of receiving HAART on unprotected anal intercourse (UAI).

METHODS: We used follow-up data from HM participating in the Amsterdam Cohort Study (1984-2000). For 1) we used all visits at which HIV- and HIV+ men aged younger than 35 years (n = 1335, 14361 visits). For 2) we used all visits of HIV+ men who actually received HAART (median time on HAART: 8.3 months, median age: 37.8 years) and had data on CD4 cell counts, HIV RNA load and sexual behavior (n = 36, 194 visits). In order to adjust for repeated measurements we applied a generalized estimating equations (GEE) method. We temporally controlled for several sociodemographic factors and additionally for CD4 cell counts, HIV RNA load and calendar time (for 2).

RESULTS: 1) The incidence of self-reported gonorrhoea increased from 1.4/100PY in 1992-1996 to 2.1/100PY after July 1996 among HIV- (p = 0.563) and from 4.9/100PY to 13.3/100PY among HIV+ (p = 0.025). In 1999, the observed HIV seroconversion incidence was 2.9/100PY. Among HIV- men practice of UAI increased from 59.6% in 1992-1996 to 65.0% after July 1996 (p = 0.002). 2) For HIV+ men, practice of UAI remained stable after actually receiving HAART. But among these men, UAI increased with higher CD4 cell counts (p = 0.076) and after HIV RNA load dropped to undetectable levels (p = 0.031).

CONCLUSIONS: Among HIV- young HM, sexual risk behavior increased after the introduction of HAART. Among HIV+ men who received HAART, UAI was related to higher CD4 cell counts and undetectable HIV RNA load. Together with the observed incidence of gonorrhoea and HIV these findings urgently call for HIV prevention interventions.

Keywords: AEGIS, Homosexuality, Risk-Taking, Sex Behavior, Sexually Transmitted Diseases, Antiretroviral Therapy, Highly Active, HIV Infections, CD4 Lymphocyte Count, Safe Sex, Incidence, HIV Seropositivity, Gonorrhea, HIV-1, Cohort Studies, Retroviridae, Human, Male, therapy, drug therapy
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ThOrC715