Estimating the Risk of HIV Transmission from Homosexual Men on Treatment to their HIV-uninfected partners
Résumé
Background: It is not known how the risk of HIV transmission from homosexual men on antiretroviral treatment is related to patterns of patient monitoring and condom use. Methods: We developed a stochastic mathematical simulation model of cohorts of men who have sex with men (MSM) in the Netherlands, parameterised using observational cohort data. The model incorporates viral load trends during first-line treatment, patient monitoring, and different scenarios for how condom use may depend on recent viral load measurements. The model does not include the effect of sexually transmitted infections on HIV transmission. Results: For MSM on treatment, the risk of transmitting HIV to their long-term partner is 22% (uncertainty interval: 9-37%) if condoms are never used. With incomplete use (in 30% of sex acts) the risk is reduced slightly, to 17% (7-29%). However, the risk is as low as 3% (0.2-8%) when men on treatment only use condoms six months beyond their last undetectable viral load measurement. The risk is further reduced when three months is the time period beyond which condoms are used. Conclusions: When condom use by HIV-infected, cART-treated men is based on their last viral load measurement, the transmission risk is much lower than with incomplete condom use. The key message for patients is that although always using condoms during treatment is the best way to protect partners from the risk of HIV transmission, when such use cannot be achieved, the second best strategy is to use condoms whenever the last undetectable viral load was measured more than three months ago.
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