Probability of HIV-1 transmission per coital act in monogamous, heterosexual, HIV-1-discordant couples in Rakai, Uganda
Probability of HIV-1 transmission per coital act in monogamous, heterosexual, HIV-1-discordant couples in Rakai, Uganda
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DOI：
10.1016/s0140-6736(00)04331-2
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发表时间：
2001-04-14
期刊：
影响因子：
168.9
通讯作者：
Quinn, TC
中科院分区：
文献类型：
--
作者：
Gray, RH;Wawer, MJ;Quinn, TC
背景 在具有代表性的非洲人群中，每次性交行为传播 HIV-1 的概率尚不清楚。我们的目的是总体计算这一概率，并估计其如何受到被认为影响传染性的各种因素的影响。方法从乌干达拉凯的人群队列中回顾性鉴定出 174 对一夫一妻制夫妇，其中一方为 HIV-1 阳性。对夫妻间的性交频率和报告可靠性进行了前瞻性评估，确定了未感染伴侣的 HIV-1 血清转化情况，并测量了感染伴侣的 HIV-1 病毒载量。通过泊松回归估计每次性交行为的调整后传播率。通过对年龄和 HIV-1 病毒载量四分位数以及 HIV-1 感染伴侣的性传播疾病 (STD) 症状或诊断进行双对数二项式回归来估计每次行为的传播概率。结果 平均性交频率为每月 8.9 次，随着年龄和 HIV-1 病毒载量的增加而下降。夫妻成员报告的性交频率相似。每次性交行为传播 HIV-1 的总体未经调整概率为 0.0011 (95% CI 0.0008-0.0015)。传播概率从病毒载量低于 1700 拷贝/mL 时每次行为 0.0001 增加到 38 500 拷贝/mL 或以上时每次行为 0.0023 (p=0.002)，生殖器溃疡时传播概率为 0.0041，无生殖器溃疡时传播概率为 0.0011 (p=0.02)。 HIV-1 A 和 D 亚型、性别、STD 或 HIV-1 阳性伴侣的排尿症状或排尿困难，每次行为的传播概率没有显着差异。 解释 在乌干达人群中，较高的病毒载量和生殖器溃疡是每次性交行为 HIV-1 传播的主要决定因素。
Background The probability of HIV-1 transmission per coital act in representative African populations is unknown. We aimed to calculate this probability overall, and to estimate how it is affected by various factors thought to influence infectivity.Methods 174 monogamous couples, in which one partner was HIV-1 positive, were retrospectively identified from a population cohort in Rakai, Uganda. Frequency of intercourse and reliability of reporting within couples was assessed prospectively, HIV-1 seroconversion was determined in the uninfected partners, and HIV-1 viral load was measured in the infected partners. Adjusted rate ratios of transmission per coital act were estimated by Poisson regression. Probabilities of transmission per act were estimated by log-log binomial regression for quartiles of age and HIV-1 viral load, and for symptoms or diagnoses of sexually transmitted diseases (STDs) in the HIV-1-infected partners.Results The mean frequency of intercourse was 8.9 per month, which declined with age and HIV-1 viral load. Members of couples reported similar frequencies of intercourse. The overall unadjusted probability of HIV-1 transmission per coital act was 0.0011 (95% CI 0.0008-0.0015). Transmission probabilities increased from 0.0001 per act at viral loads of less than 1700 copies/mL to 0.0023 per act at 38 500 copies/mL or more (p=0.002), and were 0.0041 with genital ulceration versus 0.0011 without (p=0.02). Transmission probabilities per act did not differ significantly by HIV-1 subtypes A and D, sex, STDs, or symptoms of discharge or dysuria in the HIV-l-positive partner.Interpretation Higher viral load and genital ulceration are the main determinants of HIV-1 transmission per coital act in this Ugandan population.