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University of THESOUNDCO.CO.ZA | Master | CEMS MIM

Official websites use. Share sensitive information only on official, secure websites. The level of evidence for HIV transmission risk through condomless sex in serodifferent gay couples with the HIV-positive partner taking virally suppressive antiretroviral therapy ART is limited compared with the evidence available for transmission risk in heterosexual couples. If a seroconversion occurred in the HIV-negative partner, anonymised phylogenetic analysis was done to compare HIV-1 pol and env sequences in both partners to identify linked transmissions.

Incidence rate of HIV transmission was calculated as the number of phylogenetically linked HIV infections that occurred during eligible couple-years of follow-up divided by eligible couple-years of follow-up. Our results provide a similar level of evidence on viral suppression and HIV transmission risk for gay men to that previously generated for heterosexual couples and suggest that the risk of HIV transmission in gay couples through condomless sex when HIV viral load is suppressed is effectively zero.

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Early evidence of a strong link between the HIV viral load of an HIV-positive partner and the risk of transmission to an HIV-negative partner came from observational studies in serodifferent heterosexual couples. Previous studies, including one randomised controlled trial and several observational studies, provided estimates of risk of HIV transmission through sexual intercourse in the context of virally suppressive ART. The bulk of the evidence was in heterosexual serodifferent couples and variable levels of condom use were reported in many studies.

Some evidence on transmission risk in gay men was provided in the first phase of the PARTNER study and in the Opposites Attract study, but follow-up in these studies was not sufficient to exclude a significant upper limit of risk around the study estimates of zero transmissions in gay men. By the end of follow-up, 15 new HIV infections had occurred during eligible couple-years of follow-up, but none were phylogenetically linked within-couple transmissions.

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Our findings provide a level of evidence on viral suppression and HIV transmission risk through condomless sex for gay men similar to that already reported for heterosexual couples.

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