Determinants of Per-Coital-Act HIV-1 Infectivity Among African HIV-1–Serodiscordant Couples
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Date
2012Author
Hughes, James P
Baeten, Jared M
Lingappa, Jairam R
Magaret, Amalia S
Wald, Anna
Bruyn, Guy de
Kiarie, James
Inambao, Mubiana
Kilembe, William
Farquhar, Carey
Celum, Connie
Type
ArticleLanguage
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Background. Knowledge of factors that affect per-act infectivity of human immunodeficiency virus type 1 (HIV-1) is important for designing HIV-1 prevention interventions and for the mathematical modeling of the spread of HIV-1.
Methods. We analyzed data from a prospective study of African HIV-1–serodiscordant couples. We assessed transmissions for linkage within the study partnership, based on HIV-1 sequencing. The primary exposure measure was the HIV-1–seropositive partners’ reports of number of sex acts and condom use with their study partner.
Results. Of 3297 couples experiencing 86 linked HIV-1 transmissions, the unadjusted per-act risks of unprotected male-to-female (MTF) and female-to-male (FTM) transmission were 0.0019 (95% confidence interval [CI], .0010–.0037) and 0.0010 (95% CI, .00060–.0017), respectively. After adjusting for plasma HIV-1 RNA of the HIV-1–infected partner and herpes simplex virus type 2 serostatus and age of the HIV-1–uninfected partner, we calculated the relative risk (RR) for MTF versus FTM transmission to be 1.03 (P = .93). Each log10 increase in plasma HIV-1 RNA increased the per-act risk of transmission by 2.9-fold (95% CI, 2.2–3.8). Self-reported condom use reduced the per-act risk by 78% (RR = 0.22 [95% CI, .11–.42]).
Conclusions. Modifiable risk factors for HIV-1 transmission were plasma HIV-1 RNA level and condom use, and, in HIV-1–uninfected partners, herpes simplex virus 2 infection, genital ulcers, Trichomonas vaginalis, vaginitis or cervicitis, and male circumcision.
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http://erepository.uonbi.ac.ke:8080/xmlui/handle/123456789/21421http://www.ncbi.nlm.nih.gov/pubmed/22241800
Citation
J Infect Dis. 2012 February 1; 205(3): 358–365.Publisher
Department of Obstetrics and Gynecology
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- Faculty of Health Sciences (FHS) [10378]