Sexual Activity Without Condoms and Risk of HIV Transmission in Serodifferent Couples When the HIV-Positive Partner Is Using Suppressive Antiretroviral Therapy

July 17, 2016 at 4:28 pm

JAMA July 12, 2016 V.316 N.2 P.171-181

Alison J. Rodger, MD; Valentina Cambiano, PhD; Tina Bruun, RN; Pietro Vernazza, MD; Simon Collins; Jan van Lunzen, PhD; Giulio Maria Corbelli; Vicente Estrada, MD; Anna Maria Geretti, MD; Apostolos Beloukas, PhD; David Asboe, FRCP; Pompeyo Viciana, MD; Félix Gutiérrez, MD; Bonaventura Clotet, PhD; Christian Pradier, MD; Jan Gerstoft, MD; Rainer Weber, MD; Katarina Westling, MD; Gilles Wandeler, MD; Jan M. Prins, PhD; Armin Rieger, MD; Marcel Stoeckle, MD; Tim Kümmerle, PhD; Teresa Bini, MD; Adriana Ammassari, MD; Richard Gilson, MD; Ivanka Krznaric, PhD; Matti Ristola, PhD; Robert Zangerle, MD; Pia Handberg, RN; Antonio Antela, PhD; Sris Allan, FRCP; Andrew N. Phillips, PhD; Jens Lundgren, MD; for the PARTNER Study Group

1Research Department of Infection and Population Health, University College London, London, United Kingdom

2Department of Infectious Diseases/CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

3Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital, St Gallen, Switzerland

4HIV i-Base, London, United Kingdom

5University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany

6European AIDS Treatment Group, Bruxelles, Belgium

7Hospital Clinico San Carlos and Universidad Complutense, Madrid, Spain

8Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom

9Chelsea and Westminster NHS Foundation Trust, London, United Kingdom

10Hospital Virgen del Rocío, Sevilla, Spain

11Hospital General de Elche & Universidad Miguel Hernández, Alicante, Spain

12IrsiCaixa Foundation, UAB, UVIC-UCC, Hospital Universitari “Germans Trias i Pujol,” Badalona, Catalonia, Spain

13Department of Public Health, Nice University Hospital and EA 6312, University Nice Sophia-Antipolis, France

14Rigshospitalet, Copenhagen, Denmark

15Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland

16Unit of Infectious Diseases and Dermatology, Department of Medicine, Karolinska Institutet, and Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden

17Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland

18Academic Medical Center, Amsterdam, the Netherlands

19Medical University of Vienna, Vienna, Austria

20Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland

21Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany

22Ospedal San Paolo, Milan, Italy

23Ospedale L. Spallanzani, Roma, Italy

24Praxis Driesener Straße, Berlin, Germany

25Helsinki University Central Hospital, Helsinki, Finland

26Medical University Innsbruck, Innsbruck, Austria

27Hvidovre Universitets Hospital, Hvidovre, Denamrk

28Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain

29Coventry and Warwickshire Hospital, Coventry, United Kingdom


A key factor in assessing the effectiveness and cost-effectiveness of antiretroviral therapy (ART) as a prevention strategy is the absolute risk of HIV transmission through condomless sex with suppressed HIV-1 RNA viral load for both anal and vaginal sex.


To evaluate the rate of within-couple HIV transmission (heterosexual and men who have sex with men [MSM]) during periods of sex without condoms and when the HIV-positive partner had HIV-1 RNA load less than 200 copies/mL.

Design, Setting, and Participants 

The prospective, observational PARTNER (Partners of People on ART—A New Evaluation of the Risks) study was conducted at 75 clinical sites in 14 European countries and enrolled 1166 HIV serodifferent couples (HIV-positive partner taking suppressive ART) who reported condomless sex (September 2010 to May 2014). Eligibility criteria for inclusion of couple-years of follow-up were condomless sex and HIV-1 RNA load less than 200 copies/mL. Anonymized phylogenetic analysis compared couples’ HIV-1 polymerase and envelope sequences if an HIV-negative partner became infected to determine phylogenetically linked transmissions.


Condomless sexual activity with an HIV-positive partner taking virally suppressive ART.

Main Outcomes and Measures 

Risk of within-couple HIV transmission to the HIV-negative partner


Among 1166 enrolled couples, 888 (mean age, 42 years [IQR, 35-48]; 548 heterosexual [61.7%] and 340 MSM [38.3%]) provided 1238 eligible couple-years of follow-up (median follow-up, 1.3 years [IQR, 0.8-2.0]). At baseline, couples reported condomless sex for a median of 2 years (IQR, 0.5-6.3). Condomless sex with other partners was reported by 108 HIV-negative MSM (33%) and 21 heterosexuals (4%). During follow-up, couples reported condomless sex a median of 37 times per year (IQR, 15-71), with MSM couples reporting approximately 22 000 condomless sex acts and heterosexuals approximately 36 000. Although 11 HIV-negative partners became HIV-positive (10 MSM; 1 heterosexual; 8 reported condomless sex with other partners), no phylogenetically linked transmissions occurred over eligible couple-years of follow-up, giving a rate of within-couple HIV transmission of zero, with an upper 95% confidence limit of 0.30/100 couple-years of follow-up. The upper 95% confidence limit for condomless anal sex was 0.71 per 100 couple-years of follow-up.

Conclusions and Relevance 

Among serodifferent heterosexual and MSM couples in which the HIV-positive partner was using suppressive ART and who reported condomless sex, during median follow-up of 1.3 years per couple, there were no documented cases of within-couple HIV transmission (upper 95% confidence limit, 0.30/100 couple-years of follow-up). Additional longer-term follow-up is necessary to provide more precise estimates of risk.


Entry filed under: Antirretrovirales, Epidemiología, HIV/SIDA, HIV/SIDA HAART, HIV/SIDA Mujeres, HIV/SIDA Prevencion.

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