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
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