HIV-1 heterosexual transmission and association with sexually transmitted infections in the era of treatment as prevention
HIV-1 heterosexual transmission and association with sexually transmitted infections in the era of treatment as prevention
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DOI：
10.1016/j.ijid.2019.08.004
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发表时间：
2019-10-01
影响因子：
8.4
通讯作者：
Nielsen-Saines, Karin
中科院分区：
文献类型：
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作者：
de Melo, Marineide Goncalves;Sprinz, Eduardo;Nielsen-Saines, Karin
目的：HIV-1在接受抗逆转录病毒治疗（ART）且病毒血症检测不到的个体之间的异性传播极为罕见。本研究的目的是评估在指标伴侣接受抗逆转录病毒治疗时，HIV-1血清不同的夫妇性传播HIV-1和其他性传播感染（sti）的风险。方法：对200对HIV-1阳性且关系稳定（10 ~ 3个月）的异性恋夫妇进行HIV传播评估。所有艾滋病毒阳性个体均已接受抗逆转录病毒治疗50 - 30个月，并在巴西阿雷格里港Nossa Senhora da Conceicao医院的艾滋病毒夫妇诊所进行了中位随访，随访时间为4.5年（0.3-16年）。在获得书面知情同意后，参与者回答了人口统计/行为问卷。进行HIV RNA、t细胞亚群和性传播感染（梅毒、疱疹、人乳头瘤病毒、淋病和细菌性阴道病）的定量PCR检测。自行收集阴道拭子进行HIV生殖器病毒载量定量检测。结果：200对夫妻中，70%的指标伴侣为女性。观察到5例血清转换；HIV感染率为2.5%（95%可信区间为0.8% ~ 5.7%）。HIV传递者的平均血浆病毒载量结果高于非传递者（p = 0.02）。在血清转化的夫妻中，性传播感染的存在显著增加（60.0% vs 13.3%；优势比9.75,95%可信区间1.55-61.2;p = 0.023）。无法检测到HIV病毒血症的持续时间和性传播感染的存在与HIV传播有关。结论：在这种情况下，无法检测到的病毒血症是与HIV非传播性相关的主要因素。(C) 2019作者。由爱思唯尔有限公司代表国际传染病学会出版。
Objectives: HIV-1 heterosexual transmission among individuals on antiretroviral treatment (ART) with undetectable viremia is extremely rare. The aim of this study was to evaluate the risk of sexual HIV-1 transmission and other sexually transmitted infections (STIs) in HIV-1 serodifferent couples while the index partner is on ART.Methods: HIV transmission was evaluated in 200 HIV-1 heterosexual serodifferent couples in a stable relationship (>3 months). All HIV-positive individuals had been on ART for >3 months and had been followed upfora median preceding time of 4.5 years (range 0.3-16 years) at the HIV couples clinic at Hospital Nossa Senhora da Conceicao in Porto Alegre, Brazil. Following written informed consent, participants responded to demographic/behavioral questionnaires. Quantitative PCR for HIV RNA, T-cell subsets, and STI testing (syphilis, herpes, human papillomavirus, gonorrhea, and bacterial vaginosis) were performed. Self-collected vaginal swabs were obtained for quantitative HIV genital viral load testing.Results: Among 200 couples, 70% of index partners were female. Five seroconversions were observed; the HIV infection incidence was 2.5% (95% confidence interval 0.8% to 5.7%). Mean plasma viral load results were higher in HIV transmitters compared to non-transmitters (p = 0.02). The presence of STIs was significantly greater in couples who seroconverted (60.0% vs. 13.3%; odds ratio 9.75, 95% confidence interval 1.55-61.2; p = 0.023). The duration of undetectable HIV viremia and presence of STIs were associated with HIV transmission.Conclusions: Undetectable viremia was the main factor associated with non-transmissibility of HIV in this setting. (C) 2019 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.