Combined antiretroviral treatment and heterosexual transmission of HIV-1: cross sectional and prospective cohort study.
Combined antiretroviral treatment and heterosexual transmission of HIV-1: cross sectional and prospective cohort study.
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DOI：
10.1136/bmj.c2205
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发表时间：
2010-05-14
期刊：
影响因子：
--
通讯作者：
García S
中科院分区：
文献类型：
--
作者：
Del Romero J;Castilla J;Hernando V;Rodríguez C;García S
目的了解艾滋病病毒感染者经抗逆转录病毒联合治疗后异性传播HIV-1的风险和概率。设计横断面和前瞻性队列研究。在西班牙马德里设立艾滋病诊所。参与者：稳定的异性伴侣，其中一方感染HIV-1（指数伴侣），另一方报告其性关系为唯一的风险暴露。主要结局指标衡量非指标性伴侣在入组时的艾滋病毒血清感染率，以及根据指标性伴侣接受的抗逆转录病毒治疗进行随访时的血清转化情况。结果在476对指标伴侣未接受抗逆转录病毒治疗的夫妇中，非指标伴侣入组时HIV血清阳性率为9.2% (n=44)，而在149对指标伴侣联合接受抗逆转录病毒治疗的夫妇中，无伴侣感染（P<0.001）。在随访期间，341对血清检测结果不一致且指标伴侣未接受抗逆转录病毒治疗的夫妇约有11000次无安全套性交行为，50次自然怀孕，5次HIV血清转化（每次无保护性交0.0004次，95%可信区间0.0001至0.0010）；其中294对夫妇一直使用避孕套，约有42000次性交行为，136次因避孕套失效而暴露风险，1次艾滋病毒血清转化。与使用避孕套相关的相对风险为0.07（0.01至0.58）。144对夫妇中，指数伴侣正在接受抗逆转录病毒联合治疗；他们有超过7000次无保护性交行为和47次自然怀孕，但没有艾滋病毒血清转化（每次无保护性交0至0.0005）。结论在接受有效抗逆转录病毒治疗的人群中，HIV-1的异性性感染率较低。受感染的伴侣按照议定书避免无保护的性交和接受抗逆转录病毒治疗是预防艾滋病毒传播的补充措施。
Objective To estimate the risk and probability of heterosexual transmission of HIV-1 from infected people taking combined antiretroviral treatment. Design Cross sectional and prospective cohort studies. Setting HIV clinic in Madrid, Spain. Participants Stable heterosexual couples with one partner with HIV-1 infection (index partner) and the other reporting this sexual relationship as the only risk exposure. Main outcome measures HIV seroprevalence in non-index partners at enrolment and seroconversions in follow-up according to antiretroviral treatment taken by the index partner. Results In 476 couples in which the index partner was not taking antiretroviral treatment, HIV seroprevalence at enrolment in non-index partners was 9.2% (n=44), whereas in 149 couples in which the index partner was taking combined antiretroviral therapy no partner was infected (P<0.001). During follow-up, the 341 serodiscordant couples in which the index partner was not taking antiretroviral treatment had about 11 000 acts of intercourse without condoms, 50 natural pregnancies, and five HIV seroconversions (0.0004 per unprotected intercourse; 95% confidence interval 0.0001 to 0.0010); 294 of these couples always used condoms, accounting for about 42 000 acts of intercourse, 136 risk exposures from condom failure, and one HIV seroconversion. The relative risk associated with condom use was 0.07 (0.01 to 0.58). In 144 couples the index partner was taking combined antiretroviral treatment; they accounted for over 7000 unprotected acts of intercourse and 47 natural pregnancies but no HIV seroconversion (0 to 0.0005 per unprotected intercourse). Conclusions The heterosexual infectivity of HIV-1 in individuals taking effective antiretroviral treatment is low. Avoidance of unprotected intercourse and receipt of antiretroviral treatment by the infected partner in accordance with protocols are complementary measures to prevent HIV transmission.
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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
通讯作者：
Alary, Michel
影响因子：
6.4
作者：
Fang, CT;Hsu, HM;Chuang, CY
通讯作者：
Chuang, CY
DOI：
10.1097/00042560-199604010-00010
发表时间：
1996-01-01
期刊：
JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES AND HUMAN RETROVIROLOGY
影响因子：
--
作者：
Downs, AM;DeVincenzi, I;Brunet, JB
通讯作者：
Brunet, JB
影响因子：
5.4
作者：
Di Mascio, M;Markowitz, M;Perelson, AS
通讯作者：
Perelson, AS
影响因子：
56.3
作者：
Powers, Kimberly A.;Poole, Charles;Pettifor, Audrey E.;Cohen, Myron S.
通讯作者：
Cohen, Myron S.