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ASHM CONFERENCE 2017
Undetectable Viral Load Prevents HIV Transmission in Male Serodiscordant Couples in Australia, Thailand and Brazil.
One of the first presentations in the 2017 ASHM conference was the talk that was initially given to the Paris IAS conference in July this year on the final outcomes of the Opposites Attract Study. This research was unique as its focus was on HIV transmission in HIV discordant male gay couples. This study showed no linked transmissions between discordant couples where the positive partner had an undetectable viral load. The researchers took phylogenic ‘finger-prints’ of the positive partners virus at the beginning of the study so if the other person became positive they could determine if it was the same virus. To be included on the research the gay couple had to attend at least twice per year, the positive person had a viral load, STI check and questionnaire, while the negative partner had an HIV test and STI check plus the questionnaire. The following is just a glimpse of the statistics from the research
· 343 couple were followed
· 2 international sites (Thailand and Brazil), 13 Australian sites for recruitment
· ~40% in the first year of the relationship – historically there is a larger potential for transmission in this first year compared with longer term relationships
· 75% of the pos people were on ART for the entire study, 25% commenced during the course of the study
· Of all the positive participants on ART - 75% were fully suppressed, this was due to numbers from the Thai cohort skewing the figures – the Australian cohort had much greater numbers of positive participants being fully suppressed.
· At the beginning of the study only 7% of negative men were on prep – this grew to 30 % by the end of the research
· 35% of the participants had a STI during the research period
· In the Australian cohort ~68% reported condomless anal intercourse (CAI) at the beginning of the study and 88.9% by the end.
· There were 3 partners who became positive through the project – none of these infections were linked to the positive partner. All 3 people reported CAI outside of the regular relationship
The conclusion was that with the partner having an undetectable VL there were no linked transmissions. It is not clear how the role of STI plays in this cohort with regard to transmission of HIV.