AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #80 - The burden of HIV experience and care among MSM having an HIV-positive seroconcordant steady partner: a possible research hypothesis. Results from the French VESPA ANRS EN-12 study.
Authors: Presenting Author: Dr Marie Suzan-Monti - INSERM
Additional Authors: Dr. Marie Suzan-Monti, Dr. Marie Préau, Mr. Jérôme Blanche, Ms. Sandrine Cabut, Dr. Patrizia Carrieri, Dr. France Lert, Dr. Yolande Obadia, Dr Bruno Spire,
Aim: Engaging in a relationship with a seroconcordant partner is perceived by some HIV-positive MSM as an alternative prevention strategy to consistent condom use. Beliefs of HIV-positive individuals about seroconcordance have been studied, but it is still unknown to what extent HIV clinical factors and seroconcordance are associated in HIV-positive MSM engaged in stable relationships. This study addresses the question of whether there are underlying clinical factors characterizing HIV-positive MSM engaged in seroconcordant stable.
Method / Issue: Patients were enrolled in the French national cross-sectional survey VESPA ANRS EN-12. The present analysis was restricted to male patients who defined themselves as homosexual or bisexual, and who reported being in a stable relationship for more than 12 months (n=441), monogamous or not. We selected 358 seropositive MSM having a steady partner, of whom 107 had a seroconcordant partner. Among these latter, 36 had a partner who seroconverted during the relationship and were excluded. The study group (n=322) therefore comprised 71 and 251 patients with a seroconcordant and serodiscordant partner respectively. Clinical data were collected from medical records, while psychosocial data were obtained through a standardized face-to-face questionnaire. Weighted logistic regression models were used to analyze clinical and psychosocial factors for HIV-positive MSM with a seroconcordant steady partner.
Results / Comments: Among the study population of HIV-positive MSM in stable relationships, 71 (22.1%) had a seroconcordant partner, and 220 (68.4%) were living with their steady partner. Median [IQR] age was 42[37-47], median [IQR] CD4 cell count was 523[373-755]. Ten (3.2%) were engaged in monogamous relationships. A majority of participants had one concurrent partner and 45.6% reported having had two or more sexual partners in the previous 12 months. Multiple adjustment by logistic regression showed that individuals with a seroconcordant steady partner were more likely to have a history of an AIDS-defining event or diagnosed HIV positive before 1990. Conversely, HIV-positive MSM being highly adherent to treatment and having an undetectable viral load were more likely to have a serodiscordant steady partner.
Discussion: This study demonstrates for the first time HIV clinical factors associated with seroconcordance in HIV-positive MSM engaged in stable partnerships. These individuals represent an HIV-infected population with a long and broad experience of HIV/AIDS progression. Adherence difficulties and a history of HIV progression may suggest that standard medical follow-up is not well-adapted to this population, more comprehensive care being needed to assure improved treatment response. Longitudinal studies are required to understand to what extent HIV history might influence partnership choices among HIV-positive MSM. Positive prevention programs and reinforcement of treatment adherence strategies are needed for this population and their steady sexual partners.
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