Episodic antiretroviral therapy increases hiv transmission risk compared with continuous therapy: Results of a randomized controlled trial

William Burman, Birgit Grund, Jacqueline Neuhaus, John Douglas, Gerald Friedland, Edward Telzak, Robert Colebunders, Nicholas Paton, Martin Fisher, Cornells Rietmeijer

Research output: Contribution to journalArticle

22 Scopus citations

Abstract

Objective: To compare the HIV transmission risk among patients randomized to episodic versus continuous antiretroviral therapy. Design: This was a substudy of the Strategies of Management of Antiretroviral Therapy study, in which patients were randomized to continuous versus CD4 -guided episodic antiretroviral therapy. Participants were surveyed about sexual activity and needle sharing and had laboratory testing for gonorrhea, chlamydia, and syphilis. Results: A total of 883 patients were enrolled in this study, the mean age of the patients was 45 years, 25% were women, and 78% were on antiretroviral therapy. At baseline, 136 participants (15.4%) had highrisk behavior (vaginal or anal sex without a condom, needle sharing, or incident bacterial sexually transmitted infection). After randomization, the proportion of participants reporting high-risk behavior was stable and did not differ by randomized arm (P = 0.39). Among participants off therapy at baseline, high-risk behavior was less common 4 months after randomization among those who were randomized to start antiretroviral therapy (P = 0.03). HIV transmission risk (high-risk behavior while HIV RNA level >1500 copies/mL) with partners perceived to be HIV uninfected was higher in the episodic therapy arm (P = 0.02). Conclusions: Patients on episodic antiretroviral therapy did not decrease high-risk behavior, and because HIV RNA levels were higher, this strategy may result in increased HIV transmission.

Original languageEnglish (US)
Pages (from-to)142-150
Number of pages9
JournalJournal of Acquired Immune Deficiency Syndromes
Volume49
Issue number2
DOIs
StatePublished - Oct 2008

Keywords

  • Antiretroviral therapy
  • HIV transmission risk
  • High-risk behavior
  • Randomized trial

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