Clinicians underestimate sexual risk behaviour in female patients with perinatally acquired human immunodeficiency virus infection: ANRS CO19 COVERTE cohort

Background: HAART has allowed children HIV-infected at birth to reach adulthood. Clinicians should play a key role in preventing HIV transmission in these youths. We compared patients' reports and clinicians' perceptions of sexual behaviours.
Methods: HIV-infected youths, aged 18-25 and diagnosed before 13, have been enrolled since 2010 in the multicenter ongoing ANRS-CO19-COVERTE cohort. Sociodemographic characteristics, tobacco/alcohol use and sexual behaviour are recorded in questionnaires annually completed by clinicians and patients. We compared their responses, using the κ-coefficient and the MacNemar-χ-square test. We investigated the factors associated with discordance on condom use between clinicians' and patients' reports.
Results: For the first 97 youths included in COVERTE, clinicians' and patients' reports were consistent for sociodemographic characteristics, tobacco/alcohol use, lifetime sexual activity (all κ≥0.70), age at first intercourse (κ=0.85) and contraceptive pill use (κ=0.70) (Tables 1-2). However, inconsistent condom use in the last year, in sexually active patients, was reported in 12.7% of cases by clinicians (15.4% in boys, 11.1% in girls) and in 44.6% by the patients (respectively 14.3% and 59.1%) (κ=0.26). This discordance was more frequent for girls than for boys (43.9 vs 5.3%, p=0.003), and for patients who reached high-school diploma or a lower level compared to those with a higher level (41.3% vs 0%, p=0.003). Among patients with detectable viral load at the last visit, none of the boys but 45% of the girls reported inconsistent use of condom in the last year.

At inclusion (n=97) 
Age (years) - Median (IQR)21.0 (19-24)
Female - % (n)57.7 (56)
French nationality - % (n)87.6 (85)
Living with family - % (n)51.5 (50)
<High school diploma - % (n)45.4 (44)
High school diploma - % (n)36.1 (35)
> High school diploma - % (n)18.6 (18)
Undetectable HIV viral load - % (n)68.8 (64)
CD4 cell count ≥ 500 cells/mL - % (n)60.2 (56)
[1. Living conditions and clinical characteristics]

 Clinicians' reportsPatients' reports% discordancep
Sexual experience - % (n)77.3 (75)83.5 (76)  
Age at first intercourse (years)- Median (IQR)17 (16-18)17 (16-18)  
Use of condom at first intercourse - % (n)NA98.7 (75)  
Inconsistent condom use in the last year - % (n)12.7 (9)44.6 (29)  
-- among boys15.4 (4)14.3 (3)5.30.003
-- among girls11.1 (5)59.1 (26)43.9 
-- < or = high school diploma14.0 (8)54.0 (27)41.30.003
-- > high school diploma7.1 (1)13.3 (2)0 
[2. Reports of sexual behaviours]

Conclusions: Age at first intercourse was similar in patients HIV-infected since childhood and in the French general population. Half of sexually active girls reported inconsistent condom use in the last year. Clinicians were aware of first sexual activity, but strongly underestimated at-risk sexual behaviour in girls and in those with medium and low levels of education. Active counselling could be actively recommended for these groups.

N. Briand1, J.-P. Viard2, J. Le Chenadec1, C. Dollfus3, G. Firtion4, C. Arvieux5, I. Funck-Brentano6, V. Reliquet7, V. Jeantils8, L. Boufassa1, F. Chrétien1, C. Ferey9, E. Ramos1, S. Blanche6,10, L. Meyer1,11,12, J. Warszawski1,11,12, ANRS CO19 COVERTE Study Group
1Inserm, CESP U 1018, Le Kremlin-Bicêtre Cedex, France, 2AP-HP Hôtel-Dieu, Paris, France, 3AP-HP, Hôpital Trousseau, Paris, France, 4AP-HP Hôpital Cochin Port Royal, Paris, France, 5CHU, Rennes, France, 6AP-HP Hôpital Necker-Enfants Malades, Paris, France, 7CHU Hôtel Dieu, Nantes, France, 8AP-HP Jean Verdier, Bondy, France, 9Inserm, CESP U1018, Le Kremlin-Bicêtre Cedex, France, 10Université Paris 5, Paris, France, 11Université Paris-Sud, Le Kremlin-Bicêtre, France, 12AP-HP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France