Episodic antiretroviral therapy increases HIV transmission risk compared with continuous therapy: results of a randomized controlled trial
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To compare the HIV transmission risk among patients randomized to episodic versus continuous antiretroviral therapy.
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.
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 high-risk 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).
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.
Medical Specialties | Medicine and Health Sciences | Osteopathic Medicine and Osteopathy
Klimas, Nancy G.; Burman, W.; Grund, B.; Neuhaus, J.; Douglas, J. Jr.; Friedland, G.; Telzak, E.; Colebunders, R.; Paton, N.; Fisher, M.; Rietmeijer, C.; and INSIGHT Strategies for Management of Antiretroviral Therapy (SMART) Study Group, "Episodic antiretroviral therapy increases HIV transmission risk compared with continuous therapy: results of a randomized controlled trial" (2008). Faculty Articles. 504.