Transcript 'Susceptibility to transmit HIV in ART

"Susceptibility to transmitting HIV in ARTtreated individuals:
Longitudinal analysis from Stratall ANRS 12110/ESTHER trial."
Julien COHEN1,2,3, Sylvie BOYER1,2,3, Charles KOUANFACK4, Maria Patrizia
CARRIERI1,2,3, Gilbert NDZIESSI1,2,3, Camélia PROTOPOPESCU1,2,3, Jean-Paul
MOATTI1,2,3, Eric DELAPORTE5,6, Christian LAURENT5,6, Bruno SPIRE1,2,3
and the Stratall ANRS 12110/ESTHER Study Group
INSERM, U912 (SE4S), Marseille, France
2 Université Aix Marseille, IRD, UMR-S912, Marseille, France
3 ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d’Azur, Marseille, France
4 Central Hospital, Yaoundé, Cameroon
5 Institut de Recherche pour le Développement (IRD), University Montpellier 1, UMR 145, Montpellier, France
6 Department of Infectious and Tropical Diseases, University Hospital, Montpellier, France
1
Background (1)
ART preventive intervention for reducing sexual HIV
transmission:

High efficacy of antiretroviral therapy for vertical
transmission

A 92% reduction in transmission among 3381 ARTtreated heterosexual African couples Donnel, 2010

HPTN 052 trial: Immediate ART initiation reduced
HIV-infection in sexual partners by 96% compared
with ART initiation following WHO guidelines.
Background (2)
Reduction of HIV transmission by ART
Behavioral disinhibition concerning condom use?
Longitudinal data from the ANRS STRATALL study
were used to explore :

the course of sexual risk of HIV-transmission during
the first 24 months of treatment in ART naïve HIVinfected adults

the characteristics of viremic ART-treated PLWHA
who do not consistently use condoms
Methods (1)
Stratall ANRS 12110/ESTHER :
24-month, randomized, open-label trial
Enrolled 459 HIV-infected adults followed-up in
rural district hospitals in Cameroon
Primary objective : to compare the increase in CD4
cell counts in two groups using:
 Either the recommended WHO “public health” approach
for low-income countries
 Or the standard approach used in developed countries
Methods (2)
Plasma viral load measured during clinical visits
at M0, M6, M12, M18 and M24.
Psychosocial data (including sexual behaviors
and healthcare staff’s readiness to listen)
collected
using
face-to-face
questionnaires
administered at M0, M6, M12 and M24
Methods (4)
Stable virological success (SVS) : having an
undetectable viral load (<40 copies/ml) for
more than 6 months.
Inconsistent condom use (ICU): Not using
condoms with HIV-negative partners or those
with unknown serostatus at least once in the
three months prior to the visit
Susceptibility to transmitting HIV was defined
as: lack of SVS + ICU
Methods (5)
McNemar tests were performed to assess
changes
in
ICU
and
susceptibility
to
transmitting HIV during follow-up
A mixed logistic regression model was used
to identify correlates of susceptibility to
transmitting HIV
Results (1)
Proportion of patients with detectable viral load among
patients sexually active during follow-up (n=290)
100
80
60
40
37 %
36 %
32 %
M6
M12
M24
20
0
Results (2)
Proportion of ICU among patients sexually
active during follow-up (n=290)
100
80
64 %
60
40 %
40
47 %
55 %
20
0
M0
M6
M12
M24
Results (3)
Proportion of patients susceptible to transmitting HIV
among those sexually active during follow-up (n=290)
100
80
60
64 %
40
20
23 %
26 %
22 %
M6
M12
M24
0
M0
Results (4)
Factors associated with susceptibility to transmitting HIV
(Mixed logistic regression, N=290 patients, 593 visits)
Time since ART
initiation
- M0 (ref)
- M6
- M12
- M24
More than one
sexual relationship
per week
More than one
sexual partner
Limited readiness
by health staff to
listen
AOR [95% CI]
P-value
0.14 [0.07-0.30]
0.16 [0.08-0.33]
0.11 [0.05-0.24]
2.01 [1.00-4.03]
<10-3
<10-3
<10-3
0.05
2.44 [1.12-5.34]
0.03
1.81 [1.00-3.27]
0.05
Conclusion
Despite an increase in ICU, the proportion of
individuals susceptible to transmitting HIV
decreased and remained low.
Fear of behavioral disinhibition should not be
a barrier to universal access to treatment.
Reinforcing
healthcare
staff’s
counseling
skills may be crucial for positive prevention.
Acknowledgments
Participating patients & hospital teams
Sponsorship:
- French National Agency for Research on AIDS and viral hepatitis (ANRS)
-French Public Interest Group ESTHER
-SIDACTION
The Stratall ANRS 12110/ESTHER trial Study Group
C. Kouanfack, S. Koulla-Shiro (Central hospital, Yaoundé, Cameroon); A. Bourgeois, E. Delaporte, C.
Laurent (IRD, University Montpellier 1, UMR 145, Montpellier, France); G. Laborde-Balen (French
Ministry of Foreign Affairs, Yaoundé, Cameroon); T. Atemkeng Fotsop, M. Dontsop, S. Kazé, J-M. Mben,
M-A. Ngo Hamga, Z. Tsomo (IRD, Yaoundé, Cameroon); A. Aghokeng, M.G. Edoul, E. Mpoudi-Ngolé, M.
Tongo (Virology Laboratory, IMPM/CREMER/IRD-UMR 145, Yaoundé, Cameroon); J. Blanche, S. Boyer,
M.P. Carrieri, J. Cohen, S. Loubière, M. Meresse, F. Marcellin, J-P. Moatti, B. Spire (INSERM, IRD,
University Aix Marseille, UMR 912, Marseille, France); C. Abé, S-C. Abega, C-R. Bonono, H. Mimcheu, S.
Ngo Yebga, C. Paul Bile (IRSA, Catholic University of Central Africa, Yaoundé, Cameroon); S. Abada, T.
Abanda, J. Baga, P. Bilobi Fouda, P. Etong Mve, G. Fetse Tama, H. Kemo, A. Ongodo, V. Tadewa, HD.
Voundi (District Hospital, Ayos, Cameroon); A. Ambani, M. Atangana, J-C. Biaback, M. Kennedy, H.
Kibedou, F. Kounga, M. Maguip Abanda, E. Mamang, A. Mikone, S. Tang, E. Tchuangue, S. Tchuenko, D.
Yakan (District Hospital, Bafia, Cameroon); J. Assandje, S. Ebana, D. Ebo’o, D. Etoundi, G. Ngama, P.
Mbarga Ango, J. Mbezele, G. Mbong, C. Moung, N. Ekotto, G. Nguemba Balla, G. Ottou, M. Tigougmo
(District Hospital, Mbalmayo, Cameroon); R. Beyala, B. Ebene, C. Effemba, F. Eyebe, M-M. Hadjaratou,
T. Mbarga, M. Metou, M. Ndam, B. Ngoa, EB. Ngock, N. Obam (District hospital, Mfou, Cameroon); A. M.
Abomo, G. Angoula, E. Ekassi, Essama, J.J. Lentchou, I. Mvilongo, J. Ngapou, F. Ntokombo, V. Ondoua,
R. Palawo, S. Sebe, E. Sinou, D. Wankam, I. Zobo (District hospital, Monatélé, Cameroon); B. Akono, A.
L. Ambani, L. Bilock, R. Bilo’o, J. Boombhi, F.X. Fouda, M. Guitonga, R. Mad’aa, D.R. Metou’ou, S. Mgbih,
A. Noah, M. Tadena, Ntcham (District hospital, Nanga Eboko, Cameroon); G. Ambassa Elime, A.A.
Bonongnaba, E. Foaleng, R.M. Heles, R. Messina, O. Nana Ndankou, S.A. Ngono, D. Ngono Menounga,
S.S. Sil, L. Tchouamou, B. Zambou (District hospital, Ndikinimeki, Cameroon); R. Abomo, J. Ambomo, C.
Beyomo, P. Eloundou, C. Ewole, J. Fokom, M. Mvoto, M. Ngadena, R. Nyolo, C. Onana, A. Oyie (District
hospital, Obala, Cameroon); P. Antyimi, S. Bella Mbatonga, M. Bikomo, Y. Molo Bodo, S. Ndi Ntang, P.
Ndoudoumou, L. Ndzomo, S.O. Ngolo, M. Nkengue, Nkoa, Y. Tchinda (District hospital, Sa’a, Cameroon).
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