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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References
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Journal ArticleDOI
Risk of Human Immunodeficiency Virus Infection from Unprotected Receptive Anal Intercourse Increases with Decline in Immunologic Status of Infected Partners
TL;DR: It would appear that the risk of HIV type 1 infection from unprotected receptive anal intercourse increases as the immunologic status of the HIVtype 1-infected insertive anal partner decreases.
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TL;DR: The general assumption is that students, who have a high level of education, should be well informed concerning AIDS and STDs and should therefore have positive attitudes and responsible sexual behavior, but this study demonstrates that the assumption bears no resemblance to reality.
Journal ArticleDOI
Assessing the role of anal intercourse in the epidemiology of AIDS in Africa.
TL;DR: In this paper, the authors used the Strengthening STD/HIV Control Project Kenya (SDP Kenya) baseline surveys to measure the prevalence of homosexual or heterosexual anal sex in an African context.
Journal ArticleDOI
The role of heterosexual anal intercourse for HIV transmission in developing countries: are we ready to draw conclusions?
TL;DR: The authors concluded that the rate of AI was relatively low among heterosexuals and that, “even among those who do engage in AI, most do so at significantly lower rates than VI”, and suggested that AI is unlikely to account for a large fraction of new HIV infections in Africa, but its role should not be underestimated given its higher transmission efficiency.
Journal ArticleDOI
Analytic insights into the population level impact of imperfect prophylactic HIV vaccines.
TL;DR: This work delineates the link between vaccine efficacies and the impact of vaccination at the population level and provides the tools for vaccine developers to assess the utility and effectiveness of a given imperfect vaccine straightforwardly and rapidly.
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