Saturday, February 6, 2016

Homosexual Men in HIV Serodiscordant Relationships: Implications for HIV Treatment as Prevention Research

Studies in heterosexual HIV serodiscordant couples have provided critical evidence on the role of HIV treatments in reducing HIV transmission risk. However, there are limited data regarding the effect of treatment on HIV transmission in homosexual male couples. We examined features of male homosexual HIV serodiscordant relationships that may impact upon the design of HIV treatment and transmission studies.

Data were from a prospective cohort study of HIV-negative homosexual men in Sydney, Australia. Men were followed up with six-monthly interviews and annual testing for HIV. Characteristics of men in HIV serodiscordant and seroconcordant relationships at baseline were compared, and a longitudinal analysis performed of rate of relationship break-up and of HIV incidence.

At baseline, 5.5% of participants (n=79) had an HIV-positive partner. Most (80.8%) of these relationships were non-monogamous, and 36.7% of men reported recent unprotected anal intercourse (UAI) with casual partners. The rate of relationship break-up was 29.5 per 100 person-years. Half of men in serodiscordant relationships (49.4%) reported recent UAI with their regular partners. HIV incidence was 2.2 per 100 person-years. It was substantially higher in relationships of less than one year's duration (6.1 per 100 person-years) and in men who reported unprotected receptive anal intercourse with ejaculation with their regular partners (15.5 per 100 person-years).

Levels of HIV transmission risk and incidence were high, particularly in early relationships. Rates of relationship break-up were high. These data suggest that studies of HIV treatments and transmission in homosexual serodiscordant couples should focus on early relationships so as not to underestimate risk, and sample sizes must allow for high rates of relationship break-up.

Predictors of relationship break-up in 79 homosexual men who reported being in an HIV serodiscordant relationship at baseline in the Health in Men study
Relationship break-up

PYnIncidence (per 100 PY)HR95% CIp
Length of relationship at baselinea0.034
  <6 months18.841053.091.0
 6–12 months20.43419.580.420.13–1.37
 1–2 years20.05839.890.750.30–1.91
  > 2 years103.282019.370.390.18–0.84
Age at baselinea0.010
  < 35 years53.822240.881.0
 35–45 years70.942433.830.850.47–1.51
  > 45 years41.3937.250.200.06–0.67
Partner's age at baselinea0.006
  > 5 years older17.00847.061.0
 Within 5 years80.692632.220.780.35–1.72
 >5 years younger64.38710.870.270.10–0.75
UAI with regular partner/s at baselinea0.371
 No UAI71.732940.431.0
 Insertive only58.93813.580.380.17–0.83
 Any receptive35.491238.810.890.45–1.75
ap for trend.
PY=person-years; HR=hazard ratio; 95% CI=95% confidence interval.

Full article at:

1The Kirby Institute, University of New South Wales, Sydney, Australia
2Centre for Social Research in Health, University of New South Wales, Sydney, Australia
3Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
§Corresponding author: Benjamin R Bavinton, The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia. Tel: +61 2 9385 0990. Fax: +61 2 9385 0920. (Email: ua.ude.wsnu.ybrik@notnivabb)

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