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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Sexual transmission of HIV according to viral load and antiretroviral therapy: Systematic review and meta-analysis
AIDS, Volume 23, No. 11, Year 2009
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Description
OBJECTIVES:: To synthesize the evidence on the risk of HIV transmission through unprotected sexual intercourse according to viral load and treatment with combination antiretroviral therapy (ART). DESIGN:: Systematic review and meta-analysis. METHODS:: We searched Medline, Embase and conference abstracts from 1996-2009. We included longitudinal studies of serodiscordant couples reporting on HIV transmission according to plasma viral load or use of ART and used random-effects Poisson regression models to obtain summary transmission rates [with 95% confidence intervals, (CI)]. If there were no transmission events we estimated an upper 97.5% confidence limit. RESULTS:: We identified 11 cohorts reporting on 5021 heterosexual couples and 461 HIV-transmission events. The rate of transmission overall from ART-treated patients was 0.46 (95% CI 0.19-1.09) per 100 person-years, based on five events. The transmission rate from a seropositive partner with viral load below 400 copies/ml on ART, based on two studies, was zero with an upper 97.5% confidence limit of 1.27 per 100 person-years, and 0.16 (95% CI 0.02-1.13) per 100 person-years if not on ART, based on five studies and one event. There were insufficient data to calculate rates according to the presence or absence of sexually transmitted infections, condom use, or vaginal or anal intercourse. CONCLUSION:: Studies of heterosexual discordant couples observed no transmission in patients treated with ART and with viral load below 400 copies/ml, but data were compatible with one transmission per 79 person-years. Further studies are needed to better define the risk of HIV transmission from patients on ART. © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Authors & Co-Authors
Egger, Matthias
Switzerland, Bern
University of Bern
United Kingdom, Bristol
University of Bristol
Zwahlen, Marcel
Switzerland, Bern
University of Bern
Low, Nicola M.
Switzerland, Bern
University of Bern
United Kingdom, Bristol
University of Bristol
Statistics
Citations: 780
Authors: 3
Affiliations: 2
Identifiers
Doi:
10.1097/QAD.0b013e32832b7dca
ISSN:
14735571
Research Areas
Infectious Diseases
Sexual And Reproductive Health
Study Design
Cohort Study
Study Approach
Systematic review