HIV transmission risk through anal intercourse: systematic review, meta-analysis and implications for HIV prevention
TLDR
It was demonstrated that it would require unreasonably low numbers of AI HIV exposures per partnership to reconcile the summary per-act and per-partner estimates, suggesting considerable variability in AI infectiousness between and within partnerships over time.Abstract:
Background The human immunodeficiency virus (HIV) infectiousness of anal intercourse (AI) has not been systematically reviewed, despite its role driving HIV epidemics among men who have sex with men (MSM) and its potential contribution to heterosexual spread. We assessed the per-act and per-partner HIV transmission risk from AI exposure for heterosexuals and MSM and its implications for HIV prevention.
Methods Systematic review and meta-analysis of the literature on HIV-1 infectiousness through AI was conducted. PubMed was searched to September 2008. A binomial model explored the individual risk of HIV infection with and without highly active antiretroviral therapy (HAART).
Results A total of 62 643 titles were searched; four publications reporting per-act and 12 reporting per-partner transmission estimates were included. Overall, random effects model summary estimates were 1.4% [95% confidence interval (CI) 0.2–2.5)] and 40.4% (95% CI 6.0–74.9) for per-act and per-partner unprotected receptive AI (URAI), respectively. There was no significant difference between per-act risks of URAI for heterosexuals and MSM. Per-partner unprotected insertive AI (UIAI) and combined URAI–UIAI risk were 21.7% (95% CI 0.2–43.3) and 39.9% (95% CI 22.5–57.4), respectively, with no available per-act estimates. Per-partner combined URAI–UIAI summary estimates, which adjusted for additional exposures other than AI with a ‘main’ partner [7.9% (95% CI 1.2–14.5)], were lower than crude (unadjusted) estimates [48.1% (95% CI 35.3–60.8)]. Our modelling demonstrated that it would require unreasonably low numbers of AI HIV exposures per partnership to reconcile the summary per-act and per-partner estimates, suggesting considerable variability in AI infectiousness between and within partnerships over time. AI may substantially increase HIV transmission risk even if the infected partner is receiving HAART; however, predictions are highly sensitive to infectiousness assumptions based on viral load.
Conclusions Unprotected AI is a high-risk practice for HIV transmission, probably with substantial variation in infectiousness. The significant heterogeneity between infectiousness estimates means that pooled AI HIV transmission probabilities should be used with caution. Recent reported rises in AI among heterosexuals suggest a greater understanding of the role AI plays in heterosexual sex lives may be increasingly important for HIV prevention.read more
Citations
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Heterosexual Anal Sex among Female Sex Workers in High HIV Prevalence States of India: Need for Comprehensive Intervention
Mallika Alexander,Mandar Mainkar,Sucheta Deshpande,Shweta Chidrawar,Suvarna Sane,Sanjay Mehendale +5 more
TL;DR: It is shown that despite self-risk perception for HIV, even literate FSWs with longer duration in sex work report HAS, and women controlled prevention methods, such as rectal microbicides and vaginal microbicide are needed.
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Sexual Violence against Men Who Have Sex with Men and Transgender Women in Mongolia: A Mixed-Methods Study of Scope and Consequences.
Sarah M. Peitzmeier,Faiza Yasin,Rob Stephenson,Andrea L. Wirtz,Altanchimeg Delegchoimbol,Myagmardorj Dorjgotov,Stefan Baral +6 more
TL;DR: Building on the promising strategies used in other settings to prevent and respond to sexual violence, similar strengthening of legal and social sector responses may provide much needed support to survivors and prevent future sexual violence.
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The Association Between Poor Antiretroviral Adherence and Unsafe Sex: Differences by Gender and Sexual Orientation and Implications for Scale-up of Treatment as Prevention
Robert H. Remien,Curtis Dolezal,Glenn J. Wagner,Kathy Goggin,Ira B. Wilson,Robert E. Gross,Marc I. Rosen,Jie Shen,Jane M. Simoni,Carol E. Golin,Julia H. Arnsten,David R. Bangsberg,Honghu Liu +12 more
TL;DR: HIV-infected heterosexual men who are having difficulty adhering to ART are also more likely to engage in risky sexual behaviors and therefore may benefit from counseling about these risk behaviors.
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Anal intercourse among female sex workers in East Africa is associated with other high-risk behaviours for HIV
Nienke J. Veldhuijzen,Chantal M. Ingabire,Stanley Luchters,Wilkister Bosire,Sarah L. Braunstein,Matthew Chersich,Matthew Chersich,Janneke van de Wijgert +7 more
TL;DR: AI was associated with several indicators of sexual risk behaviour and underreported due to social desirability bias, and was not associated with HIV prevalence.
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High Transmissibility During Early HIV Infection Among Men Who Have Sex With Men—San Francisco, California
T. Déirdre Hollingsworth,Christopher D. Pilcher,Frederick Hecht,Steven G. Deeks,Christophe Fraser +4 more
TL;DR: The relative transmission rate in early versus later infection among men who have sex with men in San Francisco, California, is estimated by studying the characteristics of a sample of transmitters, recruited through newly diagnosed, recently infected MSM between 1996 and 2009.
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