Determinants of Per-Coital-Act HIV-1 Infectivity Among African HIV-1-Serodiscordant Couples

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-sero...

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Bibliographic Details
Published in:The Journal of infectious diseases 2012-02, Vol.205 (3), p.358-365
Main Authors: Hughes, James P., Baeten, Jared M., Lingappa, Jairam R., Mageret, Amalia S., Wald, Anna, de Bruyn, Guy, Kiarie, James, Inambao, Mubiana, Kilembe, William, Farquhar, Carey, Celum, Connie
Format: Article
Language:English
Subjects:
Adult
Africa
Biological and medical sciences
Condoms
Condoms - utilization
Disease transmission
Family Characteristics
Female
Fundamental and applied biological sciences. Psychology
Genotype
Herpes simplex virus 2
HIV
HIV 1
HIV Infections - transmission
HIV Infections - virology
HIV-1 - classification
HIV-1 - genetics
HIV-1 - isolation & purification
HIV/AIDS
Human herpesvirus 2
Human immunodeficiency virus 1
Humans
Infections
Infectious diseases
Major and Brief Reports
Male
Medical sciences
Microbiology
Miscellaneous
Prospective Studies
Research universities
Risk Assessment
RNA
RNA, Viral - genetics
Sexual Behavior - statistics & numerical data
Sexual transmission
Trichomonas vaginalis
Vaginitis
Viral Load
Virology
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Summary: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.
ISSN:0022-1899
1537-6613
DOI:10.1093/infdis/jir747