What level of risk compensation would offset the preventive effect of early antiretroviral therapy? Simulations from the TEMPRANO trial
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
Whether risk compensation could offset the preventive effect of early initiation of antiretroviral therapy (ART) on human immunodeficiency virus (HIV) transmission remains unknown. Using virological and behavioral data collected 12 months after inclusion in the TEMPRANO randomized trial of early ART (Abidjan, Côte d'Ivoire, 2009–2012), we estimated the risk of HIV transmission and compared it between the intervention (early ART; n = 490) and control (deferred ART; n = 467) groups. We then simulated increases in various sexual risk behaviors in the intervention group and estimated the resulting preventive effect. On the basis of reported values of sexual behaviors, we estimated that early ART had an 89% (95% confidence interval: 81, 95) preventive effect on the cumulative risk of HIV transmission over a 1-month period. This preventive effect remained significant for a wide range of parameter combinations and was offset (i.e., nonsignificant) only for dramatic increases in different sexual behaviors simulated simultaneously. For example, when considering a 2-fold increase in serodiscordance and the frequency of sexual intercourse together with a 33% decrease in condom use, the resulting preventive effect was 47% (95% confidence interval: −3, 74). An important reduction of HIV transmission may thus be expected from the scale-up of early ART, even in the context of behavioral change.
Date Issued
2016-11-09
Date Acceptance
2016-09-20
Citation
American Journal of Epidemiology, 2016, 184 (10), pp.755-760
ISSN
1476-6256
Publisher
Oxford University Press
Start Page
755
End Page
760
Journal / Book Title
American Journal of Epidemiology
Volume
184
Issue
10
Copyright Statement
© 2016 Oxford University Press. This is a pre-copy-editing, author-produced PDF of an article accepted for publication in the American Journal of Epidemiology following peer review. The definitive publisher-authenticated version is available online at: http://dx.doi.org/10.1093/aje/kww127
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000392724700006&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Subjects
Science & Technology
Life Sciences & Biomedicine
Public, Environmental & Occupational Health
antiretroviral therapy
HIV
prevention
risk compensation
sexual behaviors
sub-Saharan Africa
SUB-SAHARAN AFRICA
TRANSMISSION RISK
HIV-1 INFECTION
SEXUAL-BEHAVIOR
COTE-DIVOIRE
FOLLOW-UP
METAANALYSIS
IMPACT
Epidemiology
11 Medical And Health Sciences
01 Mathematical Sciences
Publication Status
Published