HIV sexual transmission risk among serodiscordant couples: assessing the effects of combining prevention strategies.
HIV sexual transmission risk among serodiscordant couples: assessing the effects of combining prevention strategies.
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DOI：
10.1097/qad.0000000000000307
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发表时间：
2014-06-19
期刊：
影响因子：
--
通讯作者：
Mermin J
中科院分区：
文献类型：
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作者：
Lasry A;Sansom SL;Wolitski RJ;Green TA;Borkowf CB;Patel P;Mermin J
在评估抗逆转录病毒疗法、暴露前预防和男性包皮环切术的试验之后，预防艾滋病毒传播的战略数量有所增加。血清不一致的夫妇需要指导这些策略单独使用以及相互结合使用对艾滋病毒传播的影响。我们估计了艾滋病毒传播的性风险超过1年和10年期间的男性和男性之间的血清不一致的夫妇。我们假设以下传播减少：80%来自持续使用避孕套; 54%来自异性恋夫妇的阴性男性伴侣的包皮环切术; 73%来自男男伴侣的阴性伴侣的包皮环切术;异性恋夫妇的PrEP为71%;男男伴侣的PrEP为44%; 96%来自艾滋病毒感染伴侣的ART使用。对于使用任何单一预防策略的夫妇，艾滋病毒传播的累积风险仍然很大。对于只使用避孕套的男女夫妇，10年的估计风险为11%;对于只使用避孕套的男女夫妇，估计风险为76%。艾滋病毒感染的伴侣使用抗逆转录病毒疗法是降低风险的最有效的单一策略;在男-男夫妇中，增加持续使用避孕套是将10年风险保持在10%以下所必需的。关注1年和更长时间的传播概率，使夫妇比单一性行为的数据更好地了解风险。在血清不一致的夫妇中，阴性伴侣的长期传播概率可能很高，尽管通过战略性地使用预防方法，特别是包括抗逆转录病毒疗法在内的预防方法，可以大大降低这种概率。
The number of strategies to prevent HIV transmission has increased following trials evaluating antiretroviral therapy (ART), preexposure prophylaxis (PrEP) and male circumcision. Serodiscordant couples need guidance on the effects of these strategies alone, and in combination with each other, on HIV transmission. We estimated the sexual risk of HIV transmission over 1-year and 10-year periods among male–male and male–female serodiscordant couples. We assumed the following reductions in transmission: 80% from consistent condom use; 54% from circumcision in the negative male partner of a heterosexual couple; 73% from circumcision in the negative partner of a male–male couple; 71% from PrEP in heterosexual couples; 44% from PrEP in male–male couples; and 96% from ART use by the HIV-infected partner. For couples using any single prevention strategy, a substantial cumulative risk of HIV transmission remained. For a male–female couple using only condoms, estimated risk over 10 years was 11%; for a male–male couple using only condoms, estimated risk was 76%. ART use by the HIV-infected partner was the most effective single strategy in reducing risk; among male–male couples, adding consistent condom use was necessary to keep the 10-year risk below 10%. Focusing on 1-year and longer term transmission probabilities gives couples a better understanding of risk than those illustrated by data for a single sexual act. Long-term transmission probabilities to the negative partner in serodiscordant couples can be high, though these can be substantially reduced with the strategic use of preventive methods, especially those that include ART.