AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #148 - Different trends in sexual behaviour among seroconverting MSM before and after the introduction of cART
Authors: Presenting Author: mrs. Titia Heijman - Public Health Service Amsterdam
Additional Authors: Dr. Ronald Geskus, Dr. Udi Davidovich, Prof. Roel Coutinho, Prof. Maria Prins, Dr. Ineke Stolte,
Aim: To gain insight in the ongoing HIV transmission among MSM and possible contribution of aware HIV positive MSM it is important to identify changes in sexual behaviour after recent HIV diagnosis. Therefore we evaluated the change in sexual risk behaviour after HIV diagnosis among MSM seroconverters participating in the Amsterdam Cohort Study (ACS) from 1984-2008. We compared the trends in unprotected anal intercourse (UAI) in the period before 1996 (no effective anti retroviral therapy: pre-cART ) with the period from 1996 onwards (cART available).
Method / Issue: MSM in the ACS complete behavioural questionnaires and test for HIV antibodies every 6 months. We included 206 MSM who seroconverted for HIV during follow-up. UAI was defined as not or not always using a condom when engaging in AI in the preceding six months. Trends in UAI were analyzed using a random effects logistic regression model, allowing for changes in trends in the two time periods. The first HIV positive visit was the moment of HIV diagnosis. We used data from 4 years prior to 4 years following HIV diagnosis. Results are presented in probabilities of UAI. A sensitivity analysis was conducted to exclude the potential influence of cART by including cART-naive visits only.
Results / Comments: 125 MSM seroconverted in the pre-cART era and 81 MSM in the cART era. Results show an overall trend to a decrease in UAI following HIV diagnosis. The probability of UAI in the pre-cART period decreased significantly from 68% one year before HIV diagnosis to respectively 38% one year after HIV diagnosis (29% decrease [95%CI: 22%-36%]), 34% (95%CI:30%-38%) 2 years and 32% (95%CI:27%-38%) 4 years after diagnosis. In the cART period UAI decreased significantly from 72% one year before diagnosis to 53% (20% decrease [95%CI:9%-30%]) one year after diagnosis. However, from one year after diagnosis onwards probabilities increased again to 61% (95%CI 48%-74%) at 4 years after diagnosis. The risk difference of UAI (cART vs.pre-cART) increased after HIV diagnosis and reached statistical significance 1 year after diagnosis. Results of the study did not change when including only cART naive visits (180/248) in the cART period.
Discussion: This study shows reductions in UAI directly after HIV diagnosis. However, in the cART period this reduction is only temporary. Prevention efforts should reach MSM as soon as possible after their HIV diagnosis to facilitate healthy choices and prolong the period of protected anal intercourse, especially with HIV negative partners. This is now even more important than during the pre-cART period considering the changing trends in behaviour and the treatment options with cART earlier in the infection. Moreover, given the reduction in sexual risk behaviour after HIV diagnosis combined with high viral load levels early in infection, increased efforts to identify primary HIV infection remain essential in preventing onward HIV transmission.
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