Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study
The Lancet, Published Online May 2, 2019
The level of evidence for HIV transmission risk through condomless sex in serodifferent gay couples with the HIV-positive partner taking virally suppressive antiretroviral therapy (ART) is limited compared with the evidence available for transmission risk in heterosexual couples. The aim of the second phase of the PARTNER study (PARTNER2) was to provide precise estimates of transmission risk in gay serodifferent partnerships.
Between Sept 15, 2010, and July 31, 2017, 972 gay couples were enrolled, of which 782 provided 1593 eligible couple-years of follow-up with a median follow-up of 2·0 years (IQR 1·1–3·5). At baseline, median age for HIV-positive partners was 40 years (IQR 33–46) and couples reported condomless sex for a median of 1·0 years (IQR 0·4–2·9). During eligible couple-years of follow-up, couples reported condomless anal sex a total of 76 088 times. 288 (37%) of 777 HIV-negative men reported condomless sex with other partners. 15 new HIV infections occurred during eligible couple-years of follow-up, but none were phylogenetically linked within-couple transmissions, resulting in an HIV transmission rate of zero (upper 95% CI 0·23 per 100 couple-years of follow-up).
Our results provide a similar level of evidence on viral suppression and HIV transmission risk for gay men to that previously generated for heterosexual couples and suggest that the risk of HIV transmission in gay couples through condomless sex when HIV viral load is suppressed is effectively zero. Our findings support the message of the U=U (undetectable equals untransmittable) campaign, and the benefits of early testing and treatment for HIV.
Healthcare providers should inform all patients with HIV they cannot transmit HIV to a sexual partner when their viral load is undetectable, argue the authors of a strongly worded comment in The Lancet HIV.
The authors note that despite overwhelming scientific data supporting the undetectable = untransmittable (U=U) message, significant numbers of healthcare providers do not educate their patients about U=U when telling them their viral load is undetectable.
Leading Aboriginal researcher Associate Professor James Ward* is calling for action in remote Australia to deal with a preventable epidemic of sexually transmissible infections — including syphilis — in a population that’s no more sexually active than non-Indigenous people of the same age.
He joined Dr Norman Swan’s Health Report on ABC RN.
Later this month James will present to the National Rural Health Conference about addressing sexually transmitted infections in remote Australia.
*James Ward is Associate Professor, Flinders University; & Head of Infectious Diseases Research, Aboriginal Health, South Australian Health and Medical Research Institute.
The shigella outbreak is continuing in South Australia. This is to advise clinicians to be on alert for a potential increase in shigella cases, and to highlight updated recommendations on treatment as released by the Communicable Disease Control Branch (CDCB).
The outbreak is predominantly in men who have sex with men (MSM) and there is a potential for further increase in numbers related to a larger outbreak in Victoria and NSW. We encourage you to be alert for clients who have recently traveled interstate.The CDCB is now recommending that patients with confirmed multi-drug resistant (MDR) shigella (or at risk of MDR shigella while awaiting sensitivities) be treated with five days of Ceftrixaone 1g IV, rather than 1 day (as recommended in the Public Health Alert issued in December 2018).
Australia’s Therapeutic Goods Administration (TGA) recently postponed its decision on whether or not to change the law around alkyl nitrites (the active ingredient in ‘amyl’ or ‘poppers’). Currently, the TGA is conducting public consultations into the proposed amendments that could see amyl recategorised as a ‘prohibited substance’.
The legal consequence of this decision could see amyl fall into the same category as prohibited drugs like heroin, methamphetamine and cocaine, with serious penalties for their possession, use or supply. This issue has raised concerns within our communities where amyl is used during sex.
Submissions to the TGA
The deadline for written submissions to the TGA closed on 15 January 2019; however, a number of organisations expressed their concerns including:
Since its announcement, Undetectable equals Untransmittable (U=U) has become a call to action to assert that when someone living with HIV has an undetectable viral load they cannot transmit HIV. Additionally, the U=U message
is evolving to challenge notions of HIV infectivity, vulnerability and stigma.
The science behind the U=U message provides the evidence that we can reduce the anxiety related to the sexual transmission of the HIV virus with confidence.
To contribute to getting this message out, ICASO produced a Community Brief on U=U. This community brief explains why it is so important to understand what ‘U=U’ means for women. The brief documents the experiences and needs of individual women living with HIV from all over the world. Important questions still remain that need to be answered to make the U=U message relevant, understandable and more meaningful to women in their diversity.