HIV transmission risk through anal intercourse: systematic review, meta-analysis and implications for HIV prevention
Reads0
Chats0
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
More filters
Journal ArticleDOI
Intensified shigellosis epidemic associated with sexual transmission in men who have sex with men--Shigella flexneri and S. sonnei in England, 2004 to end of February 2015.
Ian Simms,Nigel Field,Nigel Field,Claire Jenkins,Tristan Childs,V L Gilbart,Timothy J. Dallman,Piers Mook,Paul Crook,Gwenda Hughes +9 more
TL;DR: Clinicians should sensitively ascertain sexual history for men with enteric infections to facilitate prompt diagnosis and appropriate management of shigellosis in men who have sex with men.
Journal ArticleDOI
HIV and mucosal barrier interactions: consequences for transmission and pathogenesis.
TL;DR: The host-pathogen relationship of HIV and mucosal barriers in both of these scenarios are detailed, with particular attention to theGI and genital tract compartments.
Journal ArticleDOI
Heterosexual HIV-1 infectiousness and antiretroviral use: systematic review of prospective studies of discordant couples.
TL;DR: ART substantially reduces HIV-1 infectiousness within discordant couples, based on observational studies, and could play a major part in HIV- 1 prevention efforts, however, the non-zero risk from partners receiving ART demonstrates that appropriate counseling and other risk-reduction strategies for discordant married couples are still required.
Journal ArticleDOI
Expert consensus statement on the science of HIV in the context of criminal law.
Françoise Barré-Sinoussi,Salim S. Abdool Karim,Salim S. Abdool Karim,Salim S. Abdool Karim,Jan Albert,Linda-Gail Bekker,Chris Beyrer,Pedro Cahn,Alexandra Calmy,Beatriz Grinsztejn,Andrew E. Grulich,Adeeba Kamarulzaman,Nagalingeswaran Kumarasamy,Mona Loutfy,Mona Loutfy,Mona Loutfy,Kamal Marhoum El Filali,Souleymane Mboup,Julio S. G. Montaner,Paula Munderi,Vadim. Pokrovsky,Anne-Mieke Vandamme,Anne-Mieke Vandamme,Benjamin Young,Peter Godfrey-Faussett,Peter Godfrey-Faussett +25 more
TL;DR: Global prosecutions for non‐disclosure, exposure or transmission of HIV frequently relate to sexual activity, biting, or spitting, which suggests prosecutions are not always guided by the best available scientific and medical evidence.
Journal ArticleDOI
HIV Incidence Among Men Who Have Sex With Men After Diagnosis With Sexually Transmitted Infections.
TL;DR: Men who have sex with men diagnosed as having rectal gonorrhea and early syphilis were at the greatest risk for being diagnosed asHaving HIV infection after STI diagnosis, and should be prioritized for more intensive prevention interventions, including PrEP.
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.
Related Papers (5)
Prevention of HIV-1 Infection with Early Antiretroviral Therapy
Myron S. Cohen,Ying Q. Chen,Marybeth McCauley,Theresa Gamble,Mina C. Hosseinipour,Nagalingeswaran Kumarasamy,James Hakim,Johnstone Kumwenda,Beatriz Grinsztejn,José Henrique Pilotto,Sheela Godbole,Sanjay Mehendale,Suwat Chariyalertsak,Breno Santos,Kenneth H. Mayer,Irving F. Hoffman,Susan H. Eshleman,Estelle Piwowar-Manning,Lei Wang,Joseph Makhema,Lisa A. Mills,Guy de Bruyn,Ian Sanne,Joseph J. Eron,Joel E. Gallant,Diane V. Havlir,Susan Swindells,Heather J. Ribaudo,Vanessa Elharrar,David N. Burns,Taha E. Taha,Karin Nielsen-Saines,David D. Celentano,Myron Essex,Thomas R. Fleming +34 more
Preexposure Chemoprophylaxis for HIV Prevention in Men Who Have Sex with Men
Robert M. Grant,Javier R. Lama,Peter L. Anderson,Vanessa McMahan,Albert Y. Liu,Lorena Vargas,Pedro Goicochea,Martin Casapia,Juan Vicente Guanira-Carranza,Maria Esther Ramirez-Cardich,Orlando Montoya-Herrera,Telmo Fernandez,Valdilea G. Veloso,Susan Buchbinder,Suwat Chariyalertsak,Mauro Schechter,Linda-Gail Bekker,Kenneth H. Mayer,Esper G. Kallas,K. Rivet Amico,Kathleen Mulligan,Lane R. Bushman,Robert J. Hance,Carmela Ganoza,Patricia Defechereux,Brian S. Postle,Furong Wang,J. Jeff McConnell,Jia-Hua Zheng,Jeanny Lee,James F. Rooney,Howard S. Jaffe,Ana Martinez,David N. Burns,David V. Glidden +34 more