16th International AIDS Conference Toronto, Canada - August 13 - 18, 2006

CHANGES IN SEXUAL BEHAVIOR AND RISK OF HIV TRANSMISSION AFTER TWO YEARS OF ANTIRETROVIRAL THERAPY AND PREVENTION INTERVENTIONS IN RURAL UGANDA

Int Conf AIDS. 2006 Aug 13-18;16 Abstract No. MoAc0204

Bunnell R.¹, Wamai N.², Ekwaru J.P.¹, Moore D.², Were W.², Bechange S.¹, Coutinho A.³, Madraa E.⁴, Mermin J.^1
1CDC-Uganda, Global AIDS Program, CDC/HHS, GAP-Uganda, Entebbe, Uganda, ²CDC-Uganda, HBAC, Tororo, Uganda, ³The AIDS Support Organisation (TASO), Kampala, Uganda, ⁴Ministry of Health, AIDS Control Programme, Kampala, Uganda

BACKGROUND: The long-term impact of antiretroviral therapy (ART) on sexual HIV transmission risk among HIV-infected persons in Africa is unknown. We assessed changes in sexual behavior and estimated HIV transmission from HIV-infected adults after 2 years of ART in Tororo, Uganda.

METHODS: Between May 2003 and December 2004 we enrolled and followed 926 drug-naive HIV-infected adults in a home-based AIDS care program that included HIV prevention counseling, voluntary counseling and testing (VCT) for cohabitating partners and condom provision. At baseline and follow-up, we assessed participants’ HIV plasma viral load and partner-specific sexual behaviors. We defined risky sex as intercourse with inconsistent or no condom use with partners of HIV-negative or unknown serostatus in the previous 3 months. We compared risky sex rates using a Poisson regression model and estimated transmission risk per partner based on established viral load-specific transmission rates. Sero-conversion rates among cohabitating sero-discordant partners with laboratory results were assessed at 24 months.

RESULTS: By January 2006, 454 (49%) participants had reached 24 months of follow-up. Sexual activity increased from 28% at baseline to 38% (p<0.001) (women: 21%-31%; men: 47-61%) at 24 months. The proportion of sexually active participants reporting any risky sex decreased from 22% to 15% (p=.062). Median viral load among those reporting risky sex was 122,500 copies/ml at baseline and undetectable at follow-up. At 2 years, the reduction in estimated risk of HIV transmission from cohort members was 98%, from 45.7 to 1.0 per 1000 person years. One sero-conversion occurred within 62 cohabitating sero-discordant partners during 1st year of therapy; no sero-conversions occurred in the second year.

CONCLUSIONS: Providing ART and on-going prevention interventions was associated with a reduced estimated risk of HIV transmission among HIV-infected Ugandan adults after two years of therapy, despite an increase in overall sexual activity. Integrated ART and prevention programs may reduce HIV transmission in Africa.

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2006-08-13
MoAc0204

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