No evidence of risk compensation over time in people living with HIV in France who have sustained undetectable viral load: results from the ANRS-Vespa2 survey
Background: People
living with HIV (PLWH) on antiretroviral therapy (ART), with sustained undetectable
viral load (UVL) and no history of other sexually transmitted infections for at
least 6 months are considered to be at low-risk of HIV transmission (LRT). This
study aimed to determine, in a representative sample of PLWH in France, whether
LRT PLWH with sustained UVL engage in risk compensation over time.
Methods: ANRS-VESPA2 was conducted from April 2011 to January 2012 on 3022 adult PLWH attending French hospitals. Socio-behavioural
(face-to-face patient interviews) and medical (questionnaires completed by
medical staff) data were collected. Fisher''s exact tests helped compare sexual
risk indicators between LRT at 6, 12, 18, 24 and 36 months of sustained UVL and their non-LRT counterparts in
three socio-epidemiological groups: men who have sex with men (MSM),
heterosexual men, and women.
Results: The present analysis included 2638 PLWH diagnosed ≥12 months and
with known duration of UVL. The percentage of LRT PLWH changed over time: 65% and
38% at M6 and M36, respectively. Results
were irrespective of time with UVL as follows: i) No difference was found between LRT and non-LRT
MSM and heterosexual men for the indicator “number of sexual partners in the
previous 12 months”; ii) LRT women were less likely to report more than one
partner than non-LRT women; iii) LRT MSM were more likely to report no sexual
partner than non-LRT MSM; iv) Globally more LRT patients reported being in sexually
inactive couples; v) No difference was found between LRT and non-LRT patients
concerning condom use with the serodiscordant steady or last casual partner, irrespective
of socio-epidemiological group.
Conclusions: Among a representative
sample of PLWH in France, non-transmitter PLWH did
not report more sexual risk behaviours than transmitters. This was true even for
those with sustained UVL for at least 3 years, i.e. since 2008, the year the Swiss Federal Commission for HIV/AIDS statement was released. Our
results do not support the hypothesis of risk compensation in PLWH presenting
non-transmission biomedical criteria. Indeed, the opposite tendency was
suggested for certain risk indicators in this representative sample.
M. Suzan-Monti1,2,3, N. Lorente1,2,3, B. Demoulin1,2,3, F. Marcellin1,2,3, M. Préau1,3,4, R. Dray-Spira5,6, B. Spire1,2,3, ANRS-Vespa-2 Study Group
1INSERM UMR 912 (SESSTIM), Marseille, France, 2Aix Marseille Université, UMR_S 912, IRD, Marseille, France, 3ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte-d'Azur, Marseille, France, 4GREPS, Université Lyon 2, Lyon, France, 5INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Team Research in Social Epidemiology, Paris, France, 6Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Team Research in Social Epidemiology, Paris, France