Less decrease in risk behaviour from pre to post HIV seroconversion among men having sex with men in the cART-era compared to the pre-cART era.

Published: December 7, 2011


To gain insight in the ongoing HIV transmission we compared sexual risk behaviour pre and post HIV-seroconversion in 206 MSM participating in the Amsterdam Cohort Studies (1984-2008) before and after the introduction of combination antiretroviral therapy(cART).

MSM completed behavioural questionnaires and were tested for HIV antibodies every 6 months. Trends in anal intercourse and number of sex partners from 4 years before HIV seroconversion until 4 years after diagnosis were analyzed with latent class random effects logistic regression models.

The risk of having unprotected anal intercourse (UAI) one year after HIV diagnosis decreased significantly when compared with one year before diagnosis in both the pre-cART era (difference=30% [95%CI:22%-36%]) and cART era (difference=19% [95%CI:9%-30%]). In contrast to a continuing decrease of UAI in the pre-cART era, the probability of UAI in the cART era increased again to pre-seroconversion levels (61% (95%CI: 48%-74%)) 4 years after diagnosis.

This study provides evidence that recently seroconverted MSM reduce their sexual risk behaviour following HIV diagnosis both in the pre-cART as well as the cART period. However, in the cART period this reduction in sexual risk behaviour is less and returns to pre-cART levels within four years. These findings not only confirm the need for early HIV-testing, but also make it clear that much more effort should go into identifying, counselling and possibly treating recently seroconverted MSM who have been found to be one of the most important drivers of HIV transmission among MSM.

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