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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Does Stigma Toward Anal Sexuality Impede HIV Prevention Among Men Who Have Sex With Men in the United States? A Structural Equation Modeling Assessment.
Bryan A. Kutner,Jane M. Simoni,Kevin M. King,Steven M. Goodreau,Andrea Norcini Pala,Emma Creegan,Frances M. Aunon,Stefan Baral,B. R. Simon Rosser +8 more
TL;DR: Providers' willingness to engage in discussion about anal sexuality, for example, by responding to questions related to sexual well-being, may function as social support and thereby bolster comfort and improve engagement in HIV prevention, to validate the Anal Health Stigma Model.
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Risk Factors Associated with HIV Among Men Who Have Sex Only with Men and Men Who Have Sex with Both Men and Women in Three Urban Areas in Mozambique
Isabel Sathane,Roberta Horth,Peter Young,Celso Inguane,Rassul Nalá,Angélica Espinosa Miranda,Tim Lane,H. Fisher Raymond,Beverley Cummings,Willi McFarland +9 more
TL;DR: Findings confirm that MSMO and MSMW have distinct HIV risks in Mozambique; HIV programs for MSM in Southern Africa should take such differences into consideration.
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Impact of Endemic Infections on HIV Susceptibility in Sub-Saharan Africa
Sergey Yegorov,Sergey Yegorov,Vineet Joag,Ronald M. Galiwango,Sara V. Good,Sara V. Good,Brenda Okech,Rupert Kaul,Rupert Kaul +8 more
TL;DR: A better understanding of the interaction between endemic infections and HIV may enhance HIV prevention programs in SSA and summarizes current knowledge of the epidemiology and underlying immunological mechanisms by which endemic infections could impact HIV acquisition.
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HIV testing and prevention among foreign-born Men Who have Sex with Men: an online survey from Sweden
Susanne Strömdahl,Fredrik Liljeros,Anna Thorson,Kristina Ingemarsdotter Persson,Birger C Forsberg +4 more
TL;DR: It is critically important to increase HIV testing among foreign-born MSM who have lived in Sweden for more than five years, and Peer outreach, individual and group counselling may be preferred interventions to do so.
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Effect of lithium on HIV-1 expression and proviral reservoir size in the CD4+ T cells of antiretroviral therapy suppressed patients.
Maria C. Puertas,Maria Salgado,Sara Morón-López,Dan Ouchi,Jose A. Muñoz-Moreno,José Moltó,Bonaventura Clotet,Javier Martinez-Picado +7 more
TL;DR: It is found that lithium carbonate treatment was able to transiently repress HIV-1 residual expression in CD4+ T cells in vivo, which led to a concomitant short-term decrease in the proviral reservoir size.
References
More filters
Journal ArticleDOI
Measuring inconsistency in meta-analyses
TL;DR: A new quantity is developed, I 2, which the authors believe gives a better measure of the consistency between trials in a meta-analysis, which is susceptible to the number of trials included in the meta- analysis.
Journal ArticleDOI
Meta-analysis of observational studies in epidemiology - A proposal for reporting
Donna F. Stroup,Jesse A. Berlin,Sally C. Morton,Ingram Olkin,G. D. Williamson,Drummond Rennie,Drummond Rennie,David Moher,Betsy Jane Becker,Theresa Ann Sipe,Stephen B. Thacker +10 more
TL;DR: A checklist contains specifications for reporting of meta-analyses of observational studies in epidemiology, including background, search strategy, methods, results, discussion, and conclusion should improve the usefulness ofMeta-an analyses for authors, reviewers, editors, readers, and decision makers.
Journal ArticleDOI
The combination of estimates from different experiments.
TL;DR: The problem of making a combined estimate has been discussed previously by Cochran and Yates and Cochran (1937) for agricultural experiments, and by Bliss (1952) for bioassays in different laboratories as discussed by the authors.
Journal ArticleDOI
Viral Load and Heterosexual Transmission of Human Immunodeficiency Virus Type 1
Thomas C. Quinn,Maria J. Wawer,Nelson K. Sewankambo,David Serwadda,Chuanjun Li,Fred Wabwire-Mangen,Mary Meehan,Tom Lutalo,Ronald H. Gray +8 more
TL;DR: The viral load is the chief predictor of the risk of heterosexual transmission of HIV-1, and transmission is rare among persons with levels of less than 1500 copies of HIV -1 RNA per milliliter.
Journal ArticleDOI
Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model
TL;DR: A theoretical strategy of universal voluntary HIV testing and immediate treatment with ART, combined with present prevention approaches, could have a major effect on severe generalised HIV/AIDS epidemics.
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