Determinants of Per-Coital-Act HIV-1 Infectivity Among African HIV-1-Serodiscordant Couples
Determinants of Per-Coital-Act HIV-1 Infectivity Among African HIV-1-Serodiscordant Couples
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DOI：
10.1093/infdis/jir747
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发表时间：
2012-02-01
影响因子：
6.4
通讯作者：
Celum, Connie
中科院分区：
文献类型：
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作者：
Hughes, James P.;Baeten, Jared M.;Celum, Connie
背景。了解影响人类免疫缺陷病毒1型（HIV-1）每动作传染性的因素对于设计HIV-1预防干预措施和建立HIV-1传播的数学模型具有重要意义。我们分析了非洲hiv -1血清不一致夫妇的前瞻性研究数据。基于HIV-1测序，我们评估了研究伙伴关系内的联系传播。主要的暴露措施是hiv -1血清阳性伴侣报告的性行为次数和与他们的研究伴侣使用安全套的情况。在经历86次HIV-1相关传播的3297对夫妇中，未经调整的无保护的男性对女性（MTF）和女性对男性（FTM）传播的每行为风险分别为0.0019（95%置信区间[CI]， 0.0010 - 0.0037）和0.0010 （95% CI, 0.0060 - 0.0017）。在校正了HIV-1感染伴侣的血浆HIV-1 RNA、HIV-1未感染伴侣的单纯疱疹病毒2型血清状态和年龄后，我们计算出MTF与FTM传播的相对风险（RR）为1.03 （P = 0.93）。血浆HIV-1 RNA每增加log(10)，每行为传播风险增加2.9倍（95% CI, 2.2-3.8）。自我报告的安全套使用减少了78%的每行为风险（RR = 0.22 [95% CI, 0.11 - 0.42]）。HIV-1传播的可改变的危险因素是血浆HIV-1 RNA水平和避孕套的使用，在HIV-1未感染的伴侣中，单纯疱疹病毒2感染、生殖器溃疡、阴道毛滴虫、阴道炎或宫颈炎和男性包皮环切术。
Background. Knowledge of factors that affect per-act infectivity of human immunodeficiency virus type 1 (HIV-1) is important for designing HIV-1 prevention interventions and for the mathematical modeling of the spread of HIV-1.Methods. We analyzed data from a prospective study of African HIV-1-serodiscordant couples. We assessed transmissions for linkage within the study partnership, based on HIV-1 sequencing. The primary exposure measure was the HIV-1-seropositive partners' reports of number of sex acts and condom use with their study partner.Results. Of 3297 couples experiencing 86 linked HIV-1 transmissions, the unadjusted per-act risks of unprotected male-to-female (MTF) and female-to-male (FTM) transmission were 0.0019 (95% confidence interval [CI], .0010-.0037) and 0.0010 (95% CI, .00060-.0017), respectively. After adjusting for plasma HIV-1 RNA of the HIV-1-infected partner and herpes simplex virus type 2 serostatus and age of the HIV-1-uninfected partner, we calculated the relative risk (RR) for MTF versus FTM transmission to be 1.03 (P = .93). Each log(10) increase in plasma HIV-1 RNA increased the per-act risk of transmission by 2.9-fold (95% CI, 2.2-3.8). Self-reported condom use reduced the per-act risk by 78% (RR = 0.22 [95% CI, .11-.42]).Conclusions. Modifiable risk factors for HIV-1 transmission were plasma HIV-1 RNA level and condom use, and, in HIV-1-uninfected partners, herpes simplex virus 2 infection, genital ulcers, Trichomonas vaginalis, vaginitis or cervicitis, and male circumcision.