Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis
Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis
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DOI：
10.1097/qad.0b013e32832b7dca
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发表时间：
2009-07-17
期刊：
影响因子：
3.8
通讯作者：
Low, Nicola
中科院分区：
文献类型：
--
作者：
Attia, Suzanna;Egger, Matthias;Low, Nicola
目的：为了综合艾滋病毒传播的风险，通过无保护的性交根据病毒载量和联合抗逆转录病毒疗法（ART）的治疗的证据设计：系统回顾和荟萃分析。方法：我们检索了1996-2009年的Medline，Embase和会议摘要。我们纳入了根据血浆病毒载量或ART使用情况报告艾滋病毒传播情况的血清不一致夫妇的纵向研究，并使用随机效应Poisson回归模型来获得汇总传播率[95%置信区间（CI）]。如果没有传播事件，我们估计的97.5%的置信上限limit.Results：我们确定了11个队列报告5021异性恋夫妇和461艾滋病毒传播事件。基于5起事件，ART治疗患者的总体传播率为0.46（95% CI 0.19-1.09）/100人-年。基于两项研究，来自病毒载量低于400拷贝/ml的血清阳性伴侣的传播率为零，97.5%置信上限为1.27/100人-年，基于五项研究和一个事件，如果不接受ART，则为0.16/100人-年（95%CI 0.02-1.13）。有足够的数据来计算率根据存在或不存在的性传播感染，避孕套的使用，或阴道或肛门interests.Conclusion：异性恋不和谐的夫妇的研究观察到没有传输与抗逆转录病毒治疗的患者和病毒载量低于400拷贝/毫升，但数据是兼容的每79人年的传输。需要进一步的研究来更好地确定接受抗逆转录病毒治疗的患者传播艾滋病毒的风险。（C）2009年威科健康|利平科特威廉姆斯&威尔金斯
Objectives: To synthesize the evidence on the risk of HIV transmission through unprotected sexual intercourse according to viral load and treatment with combination antiretroviral therapy (ART).Design: Systematic review and meta-analysis.Methods: We searched Medline, Embase and conference abstracts from 1996-2009. We included longitudinal studies of serodiscordant couples reporting on HIV transmission according to plasma viral load or use of ART and used random-effects Poisson regression models to obtain summary transmission rates [with 95% confidence intervals, (CI)]. If there were no transmission events we estimated an upper 97.5% confidence limit.Results: We identified 11 cohorts reporting on 5021 heterosexual couples and 461 HIV-transmission events. The rate of transmission overall from ART-treated patients was 0.46 (95% CI 0.19-1.09) per 100 person-years, based on five events. The transmission rate from a seropositive partner with viral load below 400copies/ml on ART, based on two studies, was zero with an upper 97.5% confidence limit of 1.27 per 100 person-years, and 0.16 (95% CI 0.02-1.13) per 100 person-years if not on ART, based on five studies and one event. There were insufficient data to calculate rates according to the presence or absence of sexually transmitted infections, condom use, or vaginal or anal intercourse.Conclusion: Studies of heterosexual discordant couples observed no transmission in patients treated with ART and with viral load below 400copies/ml, but data were compatible with one transmission per 79 person-years. Further studies are needed to better define the risk of HIV transmission from patients on ART. (C) 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins