Published in
Oxford University Press, Clinical Infectious Diseases, 10(59), p. 1483-1494, 2014
DOI: 10.1093/cid/ciu602
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Effects of HIV antiretroviral therapy on sexual and injecting risk-taking behavior: a systematic review and meta-analysis.
,
Ae E. Pedrana,
Es S. McBryde,
Stoov,
Louisa Degenhardt,
Rj J. Guy,
Er R. Weaver,
Ae E. Grulich,
Burnet Institute Department of Infectious Diseases The Alfred Hospital Department of Epidemiology and Preventative Medicine Monash University Centre for Population Health,
Yr-R. Lo,
Programs and Economics School of Population Health University of Melbourne Victoria National Drug and Alcohol Research Centre University of New South Wales Sydney Centre for Health Policy,
Mark A. Stoove,
Burnet Institute Department of Epidemiology and Preventative Medicine Monash University Centre for Population Health,
Me E. Hellard,
Burnet Institute Department of Medicine Royal Melbourne Hospital University of Melbourne Victoria Centre for Population Health
and other authors.
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Abstract
Research Support, Non-U.S. Gov't ; Review ; Meta-Analysis ; Journal Article ; BACKGROUND: Increased global access and use of antiretroviral therapy (ART) for human immunodeficiency virus (HIV) has been postulated to undermine HIV prevention efforts by changing individual risk-taking behavior. This review aims to determine whether ART use is associated with changes in sexual or injecting risk-taking behavior or diagnosis of sexually transmitted infections (STIs). METHODS: A systematic review and meta-analysis was conducted of HIV-seropositive participants receiving ART compared with no ART use in experimental or observational studies. Primary outcomes included (1) any unprotected sexual intercourse, (2) STI diagnoses, and (3) any unsafe injecting behavior. RESULTS: Fifty-eight studies met the selection criteria. Fifty-six studies containing 32 857 participants reported unprotected sex; 11 studies containing 16 138 participants reported STI diagnoses; and 4 studies containing 1600 participants reported unsafe injecting behavior. All included studies were observational. Unprotected sex was lower in participants receiving ART than in those not receiving ART (odds ratio [OR], 0.73; 95% confidence interval [CI], .64-.83; P