Rethinking the heterosexual infectivity of HIV-1: a systematic review and meta-analysis.
Rethinking the heterosexual infectivity of HIV-1: a systematic review and meta-analysis.
复制标题
DOI：
10.1016/s1473-3099(08)70156-7
复制
发表时间：
2008-09
影响因子：
56.3
通讯作者：
Cohen, Myron S.
中科院分区：
文献类型：
--
作者：
Powers, Kimberly A.;Poole, Charles;Pettifor, Audrey E.;Cohen, Myron S.
对艾滋病毒累积发病率的研究表明，生殖器溃疡病（GUD）、艾滋病毒疾病阶段和包皮环切术等辅助因素影响艾滋病毒传播;然而，艾滋病毒1型的异性感染率通常被认为是一个固定值（0.001，或每千名接触者中有1例感染）。我们试图估计传播的辅助因素对HIV-1的异性感染性的影响，并量化研究方法对感染性估计的影响程度。我们对PubMed、Web of Science和相关参考文献进行了系统检索（截至2008年4月），以识别估计HIV-1异性感染性的文章。我们使用荟萃回归和分层随机效应荟萃分析来评估辅因子和研究方法的感染性差异。感染率的估计是非常异质的，从一些血清不一致的夫妇中超过100次阴茎-阴道接触后的零传播到每3.1次异性肛交发生一次传播。估计值与研究方法仅弱相关。以每1000名接触者的传播次数表示的感染率差异（95%置信区间）为：未行包皮环切术与行包皮环切术的男性易感者之间的差异为8（0-16），有和无GUD的易感个体之间的差异为6，晚期与中期指标病例之间的差异为2，早期与中期指标病例之间的差异为3（0-5）。HIV-1异性感染性的单一值不能反映与重要辅助因子相关的变化。在稳定的夫妇中估计的通常引用的值为0.001，高风险的辅助因素的患病率较低，代表一个下限。在流行病模型、政策考虑和预防信息中必须包括辅因子效应。
Studies of cumulative HIV incidence suggest that co-factors such as genital ulcer disease (GUD), HIV disease stage, and circumcision influence HIV transmission; however, the heterosexual infectivity of HIV-1 is commonly cited as a fixed value (∼0·001, or 1 transmission per thousand contacts). We sought to estimate transmission co-factor effects on the heterosexual infectivity of HIV-1 and to quantify the extent to which study methods have affected infectivity estimates. We conducted a systematic search (through April 2008) of PubMed, Web of Science, and relevant bibliographies to identify articles estimating the heterosexual infectivity of HIV-1. We used meta-regression and stratified random-effects meta-analysis to assess differences in infectivity by co-factors and study methods. Infectivity estimates were extremely heterogeneous, ranging from zero transmissions after more than 100 penile-vaginal contacts in some sero-discordant couples to one transmission for every 3·1 episodes of heterosexual anal intercourse. Estimates were only weakly associated with study methods. Infectivity differences (95% confidence intervals), expressed as number of transmissions per 1000 contacts, were 8 (0-16) comparing uncircumcised to circumcised male susceptibles, 6 comparing susceptible individuals with and without GUD, 2 comparing late-stage to mid-stage index cases, and 3 (0-5) comparing early-stage to mid-stage index cases. A single value for the heterosexual infectivity of HIV-1 fails to reflect the variation associated with important co-factors. The commonly cited value of ∼0·001 was estimated among stable couples with low prevalences of high-risk co-factors, and represents a lower bound. Co-factor effects are important to include in epidemic models, policy considerations, and prevention messages.