Makerere University

About: Makerere University is a education organization based out in Kampala, Uganda. It is known for research contribution in the topics: Population & Public health. The organization has 7220 authors who have published 12405 publications receiving 366520 citations. The organization is also known as: Makerere University Kampala & MUK.

Rates of HIV-1 Transmission per Coital Act, by Stage of HIV-1 Infection, in Rakai, Uganda

Abstract: Background. We estimated rates of human immunodeficiency virus (HIV)‐1 transmission per coital act in HIV-discordant couples by stage of infection in the index partner. Methods. We retrospectively identified 235 monogamous, HIV-discordant couples in a Ugandan populationbased cohort. HIV transmission within pairs was confirmed by sequence analysis. Rates of transmission per coital act were estimated by the index partner’s stage of infection (recent seroconversion or prevalent or late-stage infection). The adjusted rate ratio of transmission per coital act was estimated by multivariate Poisson regression. Results. The average rate of HIV transmission was 0.0082/coital act (95% confidence interval [CI], 0.0039‐ 0.0150) within ∼2.5 months after seroconversion of the index partner; 0.0015/coital act within 6‐15 months after seroconversion of the index partner (95% CI, 0.0002‐0.0055); 0.0007/coital act (95% CI, 0.0005‐0.0010) among HIV-prevalent index partners; and 0.0028/coital act (95% CI, 0.0015‐0.0041) 6‐25 months before the death of the index partner. In adjusted models, early- and late-stage infection, higher HIV load, genital ulcer disease, and younger age of the index partner were significantly associated with higher rates of transmission. Conclusions. The rate of HIV transmission per coital act was highest during early-stage infection. This has implications for HIV prevention and for projecting the effects of antiretroviral treatment on HIV transmission. Model estimates suggest that the rate of heterosexual HIV-1 transmission per coital act follows a U-shaped curve, being highest during the postseroconversion period, lower during latency, and increasing with advancing disease [1‐4]. This is supported by findings that blood HIV load, which is higher during the postseroconversion period and during advanced disease, is the principal predictor of heterosexual transmission [5‐