Quinn T C, Wawer M J, Sewankambo N, Serwadda D, Li C, Wabwire-Mangen F, Meehan M O, Lutalo T, Gray R H
National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA.
N Engl J Med. 2000 Mar 30;342(13):921-9. doi: 10.1056/NEJM200003303421303.
We examined the influence of viral load in relation to other risk factors for the heterosexual transmission of human immunodeficiency virus type 1 (HIV-1). In a community-based study of 15,127 persons in a rural district of Uganda, we identified 415 couples in which one partner was HIV-1-positive and one was initially HIV-1-negative and followed them prospectively for up to 30 months. The incidence of HIV-1 infection per 100 person-years among the initially seronegative partners was examined in relation to behavioral and biologic variables.
The male partner was HIV-1-positive in 228 couples, and the female partner was HIV-1-positive in 187 couples. Ninety of the 415 initially HIV-1-negative partners seroconverted (incidence, 11.8 per 100 person-years). The rate of male-to-female transmission was not significantly different from the rate of female-to-male transmission (12.0 per 100 person-years vs. 11.6 per 100 person-years). The incidence of seroconversion was highest among the partners who were 15 to 19 years of age (15.3 per 100 person-years). The incidence was 16.7 per 100 person-years among 137 uncircumcised male partners, whereas there were no seroconversions among the 50 circumcised male partners (P<0.001). The mean serum HIV-1 RNA level was significantly higher among HIV-1-positive subjects whose partners seroconverted than among those whose partners did not seroconvert (90,254 copies per milliliter vs. 38,029 copies per milliliter, P=0.01). There were no instances of transmission among the 51 subjects with serum HIV-1 RNA levels of less than 1500 copies per milliliter; there was a significant dose-response relation of increased transmission with increasing viral load. In multivariate analyses of log-transformed HIV-1 RNA levels, each log increment in the viral load was associated with a rate ratio of 2.45 for seroconversion (95 percent confidence interval, 1.85 to 3.26).
The viral load is the chief predictor of the risk of heterosexual transmission of HIV-1, and transmission is rare among persons with levels of less than 1500 copies of HIV-1 RNA per milliliter.
我们研究了病毒载量对人类免疫缺陷病毒1型（HIV-1）异性传播其他危险因素的影响。在乌干达一个农村地区对15127人进行的一项基于社区的研究中，我们确定了415对夫妇，其中一方为HIV-1阳性，另一方最初为HIV-1阴性，并对他们进行了长达30个月的前瞻性随访。根据行为和生物学变量，研究了最初血清学阴性的伴侣中每100人年的HIV-1感染发生率。
228对夫妇中男性伴侣为HIV-1阳性，187对夫妇中女性伴侣为HIV-1阳性。415名最初HIV-1阴性的伴侣中有90人发生了血清转化（发生率为每100人年11.8例）。男传女的发生率与女传男的发生率无显著差异（每100人年12.0例对每100人年11.6例）。血清转化发生率在15至19岁的伴侣中最高（每100人年15.3例）。137名未行包皮环切术的男性伴侣中发生率为每100人年16.7例，而50名行包皮环切术的男性伴侣中无血清转化发生（P<0.001）。伴侣发生血清转化的HIV-1阳性受试者的平均血清HIV-1 RNA水平显著高于伴侣未发生血清转化的受试者（每毫升90254拷贝对每毫升38029拷贝，P=0.01）。51名血清HIV-1 RNA水平低于每毫升1500拷贝的受试者中无传播病例；随着病毒载量增加，传播呈显著的剂量反应关系。在对经对数转换的HIV-1 RNA水平进行多变量分析时，病毒载量每增加一个对数单位，血清转化的率比为2.45（95%置信区间，1.85至3.26）。
病毒载量是HIV-1异性传播风险的主要预测因素，在HIV-1 RNA水平低于每毫升1500拷贝的人群中传播很少见。
