Heterosexual transmission of human immunodeficiency virus - Variability of infectivity throughout the course of infection
Heterosexual transmission of human immunodeficiency virus - Variability of infectivity throughout the course of infection
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DOI：
10.1093/oxfordjournals.aje.a009564
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发表时间：
1998-07-01
影响因子：
5
通讯作者：
de Vincenzi, I
中科院分区：
文献类型：
--
作者：
Leynaert, B;Downs, AM;de Vincenzi, I
虽然感染人类免疫缺陷病毒（HIV）的个体在HIV感染的晚期阶段似乎更具传染性，也可能在血清转换期间更具传染性，但在此分析中，大多数对每次性接触传染性的估计是在不考虑感染过程中的变异性的情况下获得的，将一个概率模型拟合到1987年至1992年进行的一项欧洲研究的数据中，该研究涉及499名（359名男性和140名女性）HIV感染者（指标病例）及其固定的异性伴侣。所使用的模型允许传染性（经性接触的HIV传播概率，mu）在三个阶段变化：感染后的前3个月，随后的无症状期和晚期（HIV相关的临床症状或CD 4阳性T淋巴细胞计数低于200/mm 2（3））。男性对女性的传染性通过阴茎肛交被发现是在感染的早期和晚期阶段较高（mu = 0.183）比在较长的中间期（mu = 0.014）（p < 0.03），未能证明其他类型接触阶段之间的显著差异（男性到女性阴茎-阴道接触：mu = 0.0007;女性到男性传播：mu = 0.0005）可能反映了把握度不足，而不是真正缺乏变异性。实际上，阴茎-肛交的结果表明，处于血清转化过程中的人可能比无症状感染者更具传染性，无论接触类型如何。预防教育应强调可能不知道自己感染的受试者传播艾滋病毒的风险。
Although individuals infected with human immunodeficiency virus (HIV) seem to be more infectious in the late stages of HIV infection and possibly also during the seroconversion period, most estimates of per-sexual-contact infectivity have been obtained without allowing for variability over the course of infection, in this analysis, a probabilistic model was fitted to data from a European study carried out between 1987 and 1992 that involved 499 (359 males and 140 females) HIV-infected subjects (index cases) and their regular heterosexual partners. The model used allowed infectivity (the per-sexual-contact HIV transmission probability, mu) to vary through three stages: the first 3 months following infection, the subsequent asymptomatic period, and the advanced stage (HlV-related clinical symptoms or a CD4-positive T lymphocyte count less than 200/mm(3)). Male-to-female infectivity through penile-anal sex was found to be higher in both the early and advanced stages of infection (mu = 0.183) than in the longer intermediate period (mu = 0.014) (p < 0.03), Failure to demonstrate significant differences between stages for other types of contact (male-to-female penile-vaginal contacts: mu = 0.0007; female-to-male transmission: mu = 0.0005) may reflect insufficient power rather than a true lack of variability. Indeed, the results for penile-anal sex suggest.that persons who are in the process of seroconverting may be much more infectious than asymptomatic infected persons, whatever the type of contact. Prevention education should stress the risk of HIV transmission from subjects who may be unaware of their infection.