Heterosexual risk of HIV-1 infection per sexual act: systematic review and meta-analysis of observational studies.
Heterosexual risk of HIV-1 infection per sexual act: systematic review and meta-analysis of observational studies.
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DOI：
10.1016/s1473-3099(09)70021-0
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发表时间：
2009-02
影响因子：
56.3
通讯作者：
Alary, Michel
中科院分区：
文献类型：
--
作者：
Boily, Marie-Claude;Baggaley, Rebecca F.;Wang, Lei;Masse, Benoit;White, Richard G.;Hayes, Richard J.;Alary, Michel
我们对每次异性性接触HIV-1传播风险的观察性研究进行了系统回顾和荟萃分析。截止到2008年9月，研究人员根据25个不同的研究人群确定了43份出版物。发达国家女性对男性（0.0004,95%CI= 0.0001 - 0.0014）和男性对女性（0.0008,95%CI= 0.0006 - 0.0011）传播估计反映出在没有抗逆转录病毒药物的情况下感染风险较低。发展中国家女性对男性（0.0038，CI= 0.0013 - 0.0110）和男性对女性（0.0030，CI= 0.0014 - 0.0063）在没有商业性工作的情况下的估计值更高。在meta回归分析中，在没有CS工作的情况下，估计的传染性与性别、环境、环境和性别之间的相互作用以及艾滋病毒流行率显著相关。接受性肛交的总估计值要高得多（0.017，CI= 0.003 ~ 0.089）。HIV感染早期和晚期的估计分别是无症状期的9·2（CI=4·5-18·8）和7·3（CI=4·5-11·9）倍。在对CS暴露进行调整后，与无性传播感染相比，夫妻中任何一方存在生殖器溃疡或有生殖器溃疡史的每行为传染性增加5.3倍（CI= 1.4 - 19.5）。研究估计，未割包皮的男性至少是割包皮男性的两倍。发展中国家的估计比发达国家的估计更具异质性，这表明研究质量较差，风险因素的异质性较大，或对高风险行为的报告不足。需要努力更好地了解这些差异，并量化发展中国家的传染性。
We conducted a systematic review and meta-analysis of observational studies of the risk of HIV-1 transmission per heterosexual contact. The search to September 2008 identified 43 publications based on 25 different study populations. Pooled female-to-male (0·0004,95%CI=0·0001-0·0014) and male-to-female (0·0008,CI=0·0006-0·0011) transmission estimates in developed countries reflected a low risk of infection in the absence of antiretrovirals. Developing country female-to-male (0·0038,CI=0·0013-0·0110) and male-to-female (0·0030,CI=0·0014-0·0063) estimates in absence of commercial sex(CS) work were higher. In meta-regression analysis, the infectivity across estimates in absence of CS work was significantly associated with gender, setting, the interaction between setting and gender and HIV prevalence. The pooled receptive anal intercourse estimate was much higher (0·017,CI=0·003-0·089). Estimates for the early and late phase of HIV infection were 9·2(CI=4·5-18·8) and 7·3(CI=4·5-11·9)-fold larger than for the asymptomatic phase, respectively. After adjusting for CS exposure, presence or history of genital ulcers in either couple member increased per-act infectivity 5·3(CI=1·4-19·5)-fold compared to no sexually transmitted infection. Study estimates among non-circumcised men were at least twice those among circumcised men. Developing country estimates were more heterogeneous than developed country estimates, which indicates poorer study quality, greater heterogeneity in risk factors or under-reporting of high-risk behaviour. Efforts are needed to better understand these differences and quantify infectivity in developing countries.