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PARTNER2: ART prevents HIV transmission among gay couples
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Researchers found no cases of HIV transmission among almost 800 serodiscordant gay male couples who engaged in condomless sex while the HIV-positive partners was virally suppressed on ART and the HIV-negative partner did not report using preventative medication, according to results from the second phase of the PARTNER study published in The Lancet.
“This study provides conclusive evidence that the risk of HIV transmission through anal sex when HIV viral load is suppressed is effectively zero. This means that HIV-positive gay men on suppressive therapy are sexually noninfectious, which supports the ‘Undetectable = Untransmittable’ message,” Alison J. Rodger, MD, professor of infectious diseases at University College London, told Infectious Disease News.
“The results will challenge stigma and discrimination and have a positive impact on quality of life of HIV-positive people. They also challenge criminalization laws that continue to impact heavily on HIV-positive people for assumptions of risk that this study disproves.”
The PARTNER study began as a prospective, observational study focusing on the risk for sexual HIV transmission when an HIV-positive person is on treatment. In the first phase,
PARTNER1, Rodger and colleagues recruited and followed both heterosexual and gay serodiscordant couples from 2010 to 2014 and found no cases of partner-to-partner transmission among nearly 900 couples reporting condomless sex.
The second phase, PARTNER2, aimed to produce a similar level of evidence for transmission risk through condomless anal sex between men with suppressive ART, according to a news release.
PARTNER2 included 782 gay male serodiscordant couples from 14 European countries in which the HIV-positive partner on ART had a viral load less than 200 copies/mL and the HIV-negative partner was not using pre-exposure or post-exposure prophylaxis. Couples were eligible if they reported having condomless sex.
According to the release, participants completed questionnaires every 6 months describing how often they had sex. Clinical data with HIV viral load monitoring of the HIV-positive partner and HIV testing of the negative partner was carried out every 6 to 12 months.
Despite more than 76,000 condomless sex acts reported by gay serodiscordant couples over 8 years of follow-up, there were no HIV transmissions from the HIV-positive to the HIV-negative partner, Rodger and colleagues found. There were 15 incident infections among the couples, but none were phylogenetically linked to the other partner.
The “Undetectable = Untransmittable” campaign supports the statement that a person living with HIV who has an undetectable viral load does not transmit HIV to their partners. Results from PARTNER1 encouraged the U = U launch in 2016.
“There is now conclusive evidence that the risk of HIV transmission through anal sex when HIV viral load is suppressed is zero. HIV-positive people should be supported to take their medication as prescribed and remain in regular follow-up,” Rodger said.
“However, we also showed in the study that 15 HIV-negative men acquired HIV from other partners. So, if a person is HIV-negative and has condomless sex with other partners but doesn’t know those partners’ HIV status or if they are on ART then there could be a risk of transmission. Condoms also protect against other STIs and against pregnancy in people who have heterosexual sex. Condoms should continue to be used in these circumstances.”– by Caitlyn Stulpin
Disclosures: Rodger reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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