TITLE

Systematic Review of HIV Transmission between Heterosexual Serodiscordant Couples where the HIV-Positive Partner Is Fully Suppressed on Antiretroviral Therapy

AUTHOR(S)
Loutfy, Mona R.; Wu, Wei; Letchumanan, Michelle; Bondy, Lise; Antoniou, Tony; Margolese, Shari; Zhang, Yimeng; Rueda, Sergio; McGee, Frank; Peck, Ryan; Binder, Louise; Allard, Patricia; Rourke, Sean B.; Rochon, Paula A.
PUB. DATE
February 2013
SOURCE
PLoS ONE;Feb2013, Vol. 8 Issue 2, p1
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: The risk of sexual HIV transmission in serodiscordant couples when the HIV-positive partner has full virologic suppression on combination antiretroviral therapy (cART) is debated. This study aims to systematically review observational studies and randomized controlled trials (RCTs), evaluating rates of sexual HIV transmission between heterosexual serodiscordant couples when the HIV-positive partner has full suppression on cART. Methods and Findings: We searched major bibliographic databases to November 2012 for relevant observational studies and RCTs without language restrictions. Conference proceedings, key journals and bibliographies were also searched. Studies reporting HIV transmission rates, cART histories and viral loads of the HIV-positive partners were included. Two reviewers extracted methodologic characteristics and outcomes. Of 20,252 citations, 3 studies met all eligibility criteria with confirmed full virologic suppression in the HIV-positive partner. We included 3 additional studies (2 cohort studies, 1 RCT) that did not confirm viral suppression in the HIV-positive partner at transmission in a secondary meta-analysis. Methodologic quality was reasonable. The rate of transmission in the 3 studies confirming virologic suppression was 0 per 100 person-years (95% CI = 0–0.05), with low heterogeneity (I2 = 0%). When we included the 3 studies that did not confirm virologic suppression, the rate of transmission was 0.14 per 100 person-years (95%CI = 0.04–0.31) (I2 = 0%). In a sensitivity analysis including all 6 studies, the rate of transmission was 0 per 100 person-years (95%CI = 0–0.01) after omitting all transmissions with known detectable or unconfirmed viral loads, as full suppression in these cases was unlikely. Limitations included lack of data on same-sex couples, type of sexual intercourse (vaginal vs. anal), direction of HIV transmission, exact viral load at the time of transmission, sexually transmitted infections (STI) rates, and extent of condom use. Conclusions: Our findings suggest minimal risk of sexual HIV transmission for heterosexual serodiscordant couples when the HIV-positive partner has full viral suppression on cART with caveats regarding information on sexual intercourse type, STIs, and condom use. These findings have implications when counseling heterosexual serodiscordant couples on sexual and reproductive health. More research is needed to explore HIV transmission risk between same-sex couples.
ACCESSION #
87623968

 

Related Articles

  • Switzerland: Statement on sexual transmission of HIV by people on ART. Pearshouse, Richard // HIV/AIDS Policy & Law Review;Jul2008, Vol. 13 Issue 1, p37 

    The article reports that Swiss AIDS experts have issued a statement concluding that HIV-positive individuals who are on effective antiretroviral therapy (ART) and who do not have any sexually transmitted infections (STI) cannot transmit HIV through sexual contact. The experts reviewed studies of...

  • Characterization of Human Immunodeficiency Virus Type 1 (HIV-1) Diversity and Tropism in 145 Patients With Primary HIV-1 Infection. Rieder, Philip; Joos, Beda; Scherrer, Alexandra U.; Kuster, Herbert; Braun, Dominique; Grube, Christina; Niederöst, Barbara; Leemann, Christine; Gianella, Sara; Metzner, Karin J.; Böni, Jürg; Weber, Rainer; Günthard1, Huldrych F. // Clinical Infectious Diseases;12/15/2011, Vol. 53 Issue 12, p1271 

    Background. In the context of sexual transmission of human immunodeficiency virus type 1 (HIV-1), current findings suggest that the mucosal barrier is the major site of viral selection, transforming the complex inoculum to a small, homogeneous founder virus population. We analyzed HIV-1...

  • Determinants of loss to follow-up in patients on antiretroviral treatment, South Africa, 2004-2012: a cohort study. Mberi, Mazvita Naome; Kuonza, Lazarus Rugare; Dube, Nomathemba Michelle; Nattey, Cornelius; Manda, Samuel; Summers, Robert // BMC Health Services Research;Jul2015, Vol. 15 Issue 1, p1 

    Background: The number of Human Immunodeficiency Virus (HIV) infected people eligible for initiation on antiretroviral Therapy (ART) is increasing. ART programmatic success requires that patients who are taking ART remain on treatment and are followed up regularly. This study investigated...

  • Efavirenz-Based Regimens in Antiretroviral-Naive HIV-Infected Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Kryst, Joanna; Kawalec, Paweł; Pilc, Andrzej // PLoS ONE;May2015, Vol. 10 Issue 5, p1 

    Efavirenz, a non-nucleoside reverse-transcriptase inhibitor (NNRTI) is one of the most commonly prescribed antiretroviral drugs. The present article provides a systematic overview and meta-analysis of clinical trials comparing efavirenz and other active drugs currently recommended for treatment...

  • Risk of Cardiovascular Disease from Antiretroviral Therapy for HIV: A Systematic Review. Bavinger, Clay; Bendavid, Eran; Niehaus, Katherine; Olshen, Richard A.; Olkin, Ingram; Sundaram, Vandana; Wein, Nicole; Holodniy, Mark; Hou, Nanjiang; Owens, Douglas K.; Desai, Manisha // PLoS ONE;Mar2013, Vol. 8 Issue 3, p1 

    Background: Recent studies suggest certain antiretroviral therapy (ART) drugs are associated with increases in cardiovascular disease. Purpose: We performed a systematic review and meta-analysis to summarize the available evidence, with the goal of elucidating whether specific ART drugs...

  • ART prevented HIV transmission in serodiscordant couples.  // Infectious Disease News;Jan2013, Vol. 26 Issue 1, p8 

    The article presents a study conducted by Chinese researchers, which showed that providing antiretroviral therapy (ART) to the HIV-positive partner in a serodiscordant couple lowered the rate of HIV transmission to the uninfected partner.

  • Maintenance of endemicity in urban environments: a hypothesis linking risk, network structure and geography. Rothenberg, R. // Sexually Transmitted Infections;Feb2007, Vol. 83 Issue 1, p10 

    In industrialised countries, a rapid epidemic phase of HIV transmission has largely given way to more moderated endemic transmission. The dynamics of endemic transmission may differ substantially from those generating epidemic spread. We hypothesise that three elements play an important role in...

  • Secondary HIV transmission rates in a mixed-gender sample. Pinkerton, Steven D.; Abramson, Paul R.; Kalichman, Seth C.; Catz, Sheryl L.; Johnson-Masotti, Ana P.; Pinkerton, S D; Abramson, P R; Kalichman, S C; Catz, S L; Johnson-Masotti, A P // International Journal of STD & AIDS;Jan2000, Vol. 11 Issue 1, p38 

    Information about the sexual behaviour of HIV-infected individuals is needed to predict the course of the sexually transmitted HIV epidemic in the US. The present study provides model-based estimates of the secondary transmission rate (i.e. the number of infections expected among the sex...

  • Improving uptake of HIV testing in patients with a confirmed STI. Day, S.; Lakhani, D.; Hankins, M.; Rodgers, C.A. // International Journal of STD & AIDS;Sep2004, Vol. 15 Issue 9, p626 

    Up to 70% of GU clinic attendees with a sexually transmitted infection (STI) and undiagnosed HIV, remain HIV undiagnosed after their visit. STIs have been shown to facilitate HIV transmission. Therefore, patients with an STI should test for HIV. Our objective was to compare the uptake of HIV...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics