Joseph S Doyle1, Louisa Degenhardt2, Alisa E Pedrana3, Emma S McBryde4, Rebecca J Guy5, Mark A Stoové3, Emma R Weaver6, Andrew E Grulich5, Ying-Ru Lo7, Margaret E Hellard1. 1. Centre for Population Health, Burnet Institute Department of Infectious Diseases, The Alfred Hospital Department of Epidemiology and Preventative Medicine, Monash University. 2. Centre for Health Policy, Programs and Economics, School of Population Health, University of Melbourne, Victoria National Drug and Alcohol Research Centre, University of New South Wales, Sydney. 3. Centre for Population Health, Burnet Institute Department of Epidemiology and Preventative Medicine, Monash University. 4. Centre for Population Health, Burnet Institute Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Victoria. 5. The Kirby Institute, University of New South Wales, Sydney, Australia. 6. Centre for Population Health, Burnet Institute. 7. Department of HIV/AIDS, World Health Organization, Geneva, Switzerland.
Abstract
BACKGROUND: Increased global access and use of antiretroviral therapy (ART) for human immunodeficiency virus (HIV) has been postulated to undermine HIV prevention efforts by changing individual risk-taking behavior. This review aims to determine whether ART use is associated with changes in sexual or injecting risk-taking behavior or diagnosis of sexually transmitted infections (STIs). METHODS: A systematic review and meta-analysis was conducted of HIV-seropositive participants receiving ART compared with no ART use in experimental or observational studies. Primary outcomes included (1) any unprotected sexual intercourse, (2) STI diagnoses, and (3) any unsafe injecting behavior. RESULTS: Fifty-eight studies met the selection criteria. Fifty-six studies containing 32 857 participants reported unprotected sex; 11 studies containing 16 138 participants reported STI diagnoses; and 4 studies containing 1600 participants reported unsafe injecting behavior. All included studies were observational. Unprotected sex was lower in participants receiving ART than in those not receiving ART (odds ratio [OR], 0.73; 95% confidence interval [CI], .64-.83; P < .001; heterogeneity I(2) = 79%) in both high-income (n = 38) and low-/middle-income country (n = 18) settings, without any evidence of publication bias. STI diagnoses were also lower among individuals on ART (OR, 0.58; 95% CI, .33-1.01; P = .053; I(2) = 92%); however, there was no difference in injecting risk-taking behavior with antiretroviral use (OR, 0.90; 95% CI, .60-1.35; P = .6; I(2) = 0%). CONCLUSIONS: Despite concerns that use of ART might increase sexual or injecting risk-taking, available research suggests that unprotected sex is reduced among HIV-infected individuals on treatment. The reasons for this are not yet clear, although self-selection and mutually reinforcing effects of HIV treatment and prevention messages among people on ART are likely.
BACKGROUND: Increased global access and use of antiretroviral therapy (ART) for human immunodeficiency virus (HIV) has been postulated to undermine HIV prevention efforts by changing individual risk-taking behavior. This review aims to determine whether ART use is associated with changes in sexual or injecting risk-taking behavior or diagnosis of sexually transmitted infections (STIs). METHODS: A systematic review and meta-analysis was conducted of HIV-seropositive participants receiving ART compared with no ART use in experimental or observational studies. Primary outcomes included (1) any unprotected sexual intercourse, (2) STI diagnoses, and (3) any unsafe injecting behavior. RESULTS: Fifty-eight studies met the selection criteria. Fifty-six studies containing 32 857 participants reported unprotected sex; 11 studies containing 16 138 participants reported STI diagnoses; and 4 studies containing 1600 participants reported unsafe injecting behavior. All included studies were observational. Unprotected sex was lower in participants receiving ART than in those not receiving ART (odds ratio [OR], 0.73; 95% confidence interval [CI], .64-.83; P < .001; heterogeneity I(2) = 79%) in both high-income (n = 38) and low-/middle-income country (n = 18) settings, without any evidence of publication bias. STI diagnoses were also lower among individuals on ART (OR, 0.58; 95% CI, .33-1.01; P = .053; I(2) = 92%); however, there was no difference in injecting risk-taking behavior with antiretroviral use (OR, 0.90; 95% CI, .60-1.35; P = .6; I(2) = 0%). CONCLUSIONS: Despite concerns that use of ART might increase sexual or injecting risk-taking, available research suggests that unprotected sex is reduced among HIV-infected individuals on treatment. The reasons for this are not yet clear, although self-selection and mutually reinforcing effects of HIV treatment and prevention messages among people on ART are likely.
Authors: Bea Vuylsteke; Gisèle Semdé; Andrew F Auld; Jennifer Sabatier; Joseph Kouakou; Virginie Ettiègne-Traoré; Anne Buvé; Marie Laga Journal: J Acquir Immune Defic Syndr Date: 2015-03-01 Impact factor: 3.731
Authors: James R Hébert; Edward A Frongillo; Swann A Adams; Gabrielle M Turner-McGrievy; Thomas G Hurley; Donald R Miller; Ira S Ockene Journal: Adv Nutr Date: 2016-05-16 Impact factor: 8.701
Authors: Andrew Mujugira; Connie Celum; Kenneth Ngure; Katherine K Thomas; Elly Katabira; Jared M Baeten Journal: Sex Transm Dis Date: 2017-01 Impact factor: 2.830
Authors: William C Goedel; Maximilian R F King; Mark N Lurie; Sandro Galea; Jeffrey P Townsend; Alison P Galvani; Samuel R Friedman; Brandon D L Marshall Journal: Clin Infect Dis Date: 2020-03-03 Impact factor: 9.079
Authors: Xiao Zang; Williams C Goedel; Sam E Bessey; Mark N Lurie; Sandro Galea; Alison P Galvani; Samuel R Friedman; Bohdan Nosyk; Brandon D L Marshall Journal: AIDS Date: 2022-02-24 Impact factor: 4.632
Authors: William C Goedel; Perry N Halkitis; Richard E Greene; DeMarc A Hickson; Dustin T Duncan Journal: J Assoc Nurses AIDS Care Date: 2015-11-18 Impact factor: 1.354
Authors: Brian Houle; Shao-Tzu Yu; Nicole Angotti; Enid Schatz; Chodziwadziwa W Kabudula; Francesc Xavier Gómez-Olivé; Samuel J Clark; Jane Menken; Sanyu A Mojola Journal: Arch Sex Behav Date: 2020-03-30
Authors: Michalina A Montaño; Ricardo Alfaro; Tara Ness; Carmela Ganoza; Pedro Gonzales; Jorge Sanchez; Javier R Lama; Ann C Duerr Journal: Sex Transm Dis Date: 2020-12 Impact factor: 3.868
Authors: Muhamadi Lubega; Neema Nakyaanjo; Sumaya Nansubuga; Edgar Hiire; Godfrey Kigozi; Gertrude Nakigozi; Tom Lutalo; Fred Nalugoda; David Serwadda; Ronald Gray; Maria Wawer; Caitlin Kennedy; Steven James Reynolds Journal: BMC Public Health Date: 2015-10-08 Impact factor: 3.295