Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark.
HIV Med. 2010 Aug;11(7):457-61. doi: 10.1111/j.1468-1293.2009.00813.x. Epub 2010 Feb 9.
According to the Swiss Federal Commission for HIV/AIDS, HIV-infected patients on successful antiretroviral treatment have a negligible risk of transmitting HIV sexually. We estimated the risk that patients considered to have an undetectable viral load (VL) are actually viraemic.
A Danish, population-based nationwide cohort study of HIV-infected patients with VL <51 HIV-1 RNA copies/mL for more than 6 months was carried out for the study period 2000-2008. The observation time was calculated from 6 months after the first VL <51 copies/mL to the last measurement of VL or the first VL >50 copies/mL. The time at risk of transmitting HIV sexually was calculated as 50% of the time from the last VL <51 copies/mL to the subsequent VL if it was >1000 copies/mL. The outcome was the time at risk of transmitting HIV sexually divided by the observation time.
We identified 2680 study subjects contributing 9347.7 years of observation time and 56.4 years of risk of transmitting HIV (VL>1000 copies/mL). In 0.6% [95% confidence interval (CI) 0.5-0.8%] of the overall observation time the patients had VL >1000 copies/mL. In the first 6 months this risk was substantially higher (7.9%; 95% CI 4.5-11.0%), but thereafter decreased and was almost negligible after 5 years (0.03%; 95% CI 0.0-0.2%). The risk was higher in injecting drug users, but otherwise did not differ between subgroups of patients.
The risk of viraemia and therefore the risk of transmitting HIV sexually are high in the first 12 months of successful antiretroviral treatment, but thereafter are low.
根据瑞士联邦艾滋病毒/艾滋病委员会的报告，接受成功抗逆转录病毒治疗的艾滋病毒感染者通过性传播感染艾滋病毒的风险可忽略不计。我们评估了认为病毒载量（VL）不可检测的患者实际上存在病毒血症的风险。
对 2000 年至 2008 年期间接受 VL<51 HIV-1 RNA 拷贝/ml 且持续超过 6 个月的 HIV 感染者进行了一项丹麦全国基于人群的队列研究。观察时间从首次 VL<51 拷贝/ml 后 6 个月开始计算，至最后一次 VL 测量或首次 VL>50 拷贝/ml 时结束。具有传染性的 HIV 性传播风险时间计算为从最后一次 VL<51 拷贝/ml 到随后 VL 如果>1000 拷贝/ml 的时间的 50%。结果是具有传染性的 HIV 性传播风险时间除以观察时间。
我们确定了 2680 名研究对象，共提供了 9347.7 年的观察时间和 56.4 年的 HIV 传播风险（VL>1000 拷贝/ml）。在整个观察时间的 0.6%（95%可信区间 0.5-0.8%）中，患者的 VL>1000 拷贝/ml。在前 6 个月，这种风险显著更高（7.9%；95%可信区间 4.5-11.0%），但此后降低，5 年后几乎可以忽略不计（0.03%；95%可信区间 0.0-0.2%）。这种风险在注射吸毒者中更高，但在患者的亚组之间没有差异。
在成功抗逆转录病毒治疗的最初 12 个月中，病毒血症的风险（因此，性传播 HIV 的风险）很高，但此后风险较低。
