HIV transmission risk through anal intercourse: systematic review, meta-analysis and implications for HIV prevention.
HIV transmission risk through anal intercourse: systematic review, meta-analysis and implications for HIV prevention.
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DOI：
10.1093/ije/dyq057
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发表时间：
2010-08
影响因子：
7.7
通讯作者：
Boily MC
中科院分区：
文献类型：
--
作者：
Baggaley RF;White RG;Boily MC
背景 尽管肛交（AI）的人类免疫缺陷病毒（HIV）传染性在推动男男性接触者（MSM）中艾滋病毒流行的作用以及其对异性传播的潜在贡献方面尚未得到系统评价。我们评估了异性恋者和男男性行为者因接触人工智能而导致的每行为和每伴侣艾滋病毒传播风险及其对艾滋病毒预防的影响。方法 通过人工智能对有关 HIV-1 传染性的文献进行系统回顾和荟萃分析。 PubMed 检索至 2008 年 9 月。二项式模型探讨了使用或不使用高效抗逆转录病毒治疗 (HAART) 时感染 HIV 的个体风险。结果 共检索到62 643篇文献；其中包括四份报告每个行为的出版物和 12 份报告每个合作伙伴传播估计数的出版物。总体而言，对于每个行为和每个伙伴的无保护接受性 AI (URAI)，随机效应模型总结估计值分别为 1.4% [95% 置信区间 (CI) 0.2–2.5)] 和 40.4% (95% CI 6.0–74.9)。异性恋者和 MSM 的每次 URAI 风险没有显着差异。每个伴侣的无保护插入性 AI (UIAI) 和 URAI-UIAI 组合风险分别为 21.7% (95% CI 0.2–43.3) 和 39.9% (95% CI 22.5–57.4)，没有可用的每次行为估计。每个合作伙伴的 URAI-UIAI 综合估计总结，对除与“主要”合作伙伴的 AI 之外的额外风险进行调整后 [7.9% (95% CI 1.2–14.5)]，低于粗略（未调整）估计 [48.1% (95% CI 35.3–60.8)]。我们的模型表明，每个伙伴关系需要不合理的低数量的 AI HIV 暴露来协调每个行为和每个伙伴的估计摘要，这表明随着时间的推移，伙伴关系之间和内部的 AI 传染性存在相当大的变化。即使受感染的伴侣正在接受高效抗逆转录病毒疗法（HAART），人工智能也可能大幅增加艾滋病毒传播风险；然而，预测对基于病毒载量的传染性假设高度敏感。结论 无保护的 AI 是 HIV 传播的高风险行为，其传染性可能存在很大差异。传染性估计之间的显着异质性意味着应谨慎使用汇总的 AI HIV 传播概率。最近报道的异性恋者中人工智能的增加表明，更好地了解人工智能在异性性生活中发挥的作用对于预防艾滋病毒可能越来越重要。
Background The human immunodeficiency virus (HIV) infectiousness of anal intercourse (AI) has not been systematically reviewed, despite its role driving HIV epidemics among men who have sex with men (MSM) and its potential contribution to heterosexual spread. We assessed the per-act and per-partner HIV transmission risk from AI exposure for heterosexuals and MSM and its implications for HIV prevention. Methods Systematic review and meta-analysis of the literature on HIV-1 infectiousness through AI was conducted. PubMed was searched to September 2008. A binomial model explored the individual risk of HIV infection with and without highly active antiretroviral therapy (HAART). Results A total of 62 643 titles were searched; four publications reporting per-act and 12 reporting per-partner transmission estimates were included. Overall, random effects model summary estimates were 1.4% [95% confidence interval (CI) 0.2–2.5)] and 40.4% (95% CI 6.0–74.9) for per-act and per-partner unprotected receptive AI (URAI), respectively. There was no significant difference between per-act risks of URAI for heterosexuals and MSM. Per-partner unprotected insertive AI (UIAI) and combined URAI–UIAI risk were 21.7% (95% CI 0.2–43.3) and 39.9% (95% CI 22.5–57.4), respectively, with no available per-act estimates. Per-partner combined URAI–UIAI summary estimates, which adjusted for additional exposures other than AI with a ‘main’ partner [7.9% (95% CI 1.2–14.5)], were lower than crude (unadjusted) estimates [48.1% (95% CI 35.3–60.8)]. Our modelling demonstrated that it would require unreasonably low numbers of AI HIV exposures per partnership to reconcile the summary per-act and per-partner estimates, suggesting considerable variability in AI infectiousness between and within partnerships over time. AI may substantially increase HIV transmission risk even if the infected partner is receiving HAART; however, predictions are highly sensitive to infectiousness assumptions based on viral load. Conclusions Unprotected AI is a high-risk practice for HIV transmission, probably with substantial variation in infectiousness. The significant heterogeneity between infectiousness estimates means that pooled AI HIV transmission probabilities should be used with caution. Recent reported rises in AI among heterosexuals suggest a greater understanding of the role AI plays in heterosexual sex lives may be increasingly important for HIV prevention.
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影响因子：
56.3
作者：
Cutler, Blayne;Justman, Jessica
通讯作者：
Justman, Jessica
影响因子：
56.3
作者：
Boily, Marie-Claude;Baggaley, Rebecca F.;Wang, Lei;Masse, Benoit;White, Richard G.;Hayes, Richard J.;Alary, Michel
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影响因子：
6.4
作者：
BELEC, L;DUPRE, T;PILLOT, J
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PILLOT, J
影响因子：
7.7
作者：
Baggaley RF;White RG;Boily MC
通讯作者：
Boily MC
影响因子：
3.1
作者：
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通讯作者：
Foxman, B