HIV transmission risk through anal intercourse: systematic review, meta-analysis and implications for HIV prevention
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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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Replacement of conventional HIV testing with rapid testing: mathematical modelling to predict the impact on further HIV transmission between men
David Wilson,Christopher K Fairley,Daniel Sankar,Henrietta Williams,Phillip Keen,Tim R H Read,Marcus Y Chen +6 more
TL;DR: Rapid tests would have a marginal benefit in reducing HIV transmission between men compared with conventional tests under assumptions of no changes in testing frequencies.
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TL;DR: The results enrich the understanding of the phenotypic variation existing among natural HIV-1 viruses and how that might impact the ability of the immune system to recognize infected cells in acute and chronic infection.
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Infection Pressure in Men Who Have Sex With Men and Their Suitability to Donate Blood.
Ward P H van Bilsen,Hans L. Zaaijer,Amy Matser,Katja van den Hurk,Ed Slot,Maarten F. Schim van der Loeff,Maria Prins,Thijs J W van de Laar +7 more
TL;DR: Although lr-MSM might form a low threat for blood safety with regard to class A infections, the high seroprevalence of human herpesviruses in lr -MSM warrants further investigation.
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HIV-1 exposure and immune activation enhance sexual transmission of Hepatitis C virus by primary Langerhans cells.
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TL;DR: This work investigated the role of Langerhans cells (LCs) in HCV susceptibility during sexual contact as LCs are among the first cells in mucosal tissues to encounter invading viruses.
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Assessment of PrEP eligibility and uptake among at-risk MSM participating in a HIV-1 vaccine feasibility cohort in coastal Kenya
Elizabeth Wahome,Susan M. Graham,Alexander N Thiong'o,Oscar Chirro,Khamisi Mohamed,Evans Gichuru,John Mwambi,Matthew Price,Matthew Price,Eduard J. Sanders,Eduard J. Sanders +10 more
TL;DR: Assessing PrEP eligibility using the CDHRS identified 20% more at- risk MSM for PrEP initiation than when Kenyan Ministry of Health criteria were used, suggesting that PrEP is acceptable among at-risk MSM.
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