接受高效抗逆转录病毒治疗的HIV感染者未将病毒传播给其异性血清学不一致的伴侣。

Absence of transmission from HIV-infected individuals with HAART to their heterosexual serodiscordant partners.

作者信息

Del Romero Jorge, Río Isabel, Castilla Jesús, Baza Begoña, Paredes Vanessa, Vera Mar, Rodríguez Carmen

机构信息

Centro Sanitario Sandoval, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain.

CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Centro Nacional de Epidemiología, Instituto de Salud Carlos III (ISCIII), Madrid, Spain.

出版信息

Enferm Infecc Microbiol Clin. 2015 Dec;33(10):666-72. doi: 10.1016/j.eimc.2014.10.020. Epub 2014 Dec 30.

DOI:10.1016/j.eimc.2014.10.020

PMID:25555636

Abstract

BACKGROUND

Further studies are needed to evaluate the level of effectiveness and durability of HAART to reduce the risk of HIV sexual transmission in serodiscordant couples having unprotected sexual practices.

METHODS

A cross-sectional study was conducted with prospective cohort of heterosexual HIV serodiscordant couples where the only risk factor for HIV transmission to the uninfected partner (sexual partner) was the sexual relationship with the infected partner (index case). HIV prevalence in sexual partners at enrolment and seroconversions in follow-up were compared by antiretroviral treatment in the index partner, HIV plasma viral load in index cases and sexual risk exposures in sexual partners. In each visit, an evaluation of the risks for HIV transmission, preventive counselling and screening for genitourinary infections in the sexual partner was performed, as well as the determination of the immunological and virological situation and antiretroviral treatment in the index case.

RESULTS

At enrolment no HIV infection was detected in 202 couples where the index case was taking HAART. HIV prevalence in sexual partners was 9.6% in 491 couples where the index case was not taking antiretroviral treatment (p<0.001). During follow-up there was no HIV seroconversion among 199 partners whose index case was taking HAART, accruing 7600 risky sexual exposures and 85 natural pregnancies. Among 359 couples whose index case was not under antiretroviral treatment, over 13,000 risky sexual exposures and 5 HIV seroconversions of sexual partners were recorded. The percentage of seroconversion among couples having risky sexual intercourse was 2.5 (95% confidence interval [CI]: 1.1-5.6) when the index case did not undergo antiretroviral treatment and zero (95% CI: 0-3.2) when the index case received HAART.

CONCLUSIONS

The risk of sexual transmission of HIV from individuals with HAART to their heterosexual partners can become extremely low.

摘要

背景

需要进一步研究以评估高效抗逆转录病毒治疗（HAART）在降低血清学不一致夫妇无保护性行为中HIV性传播风险方面的有效性水平和持久性。

方法

对异性恋HIV血清学不一致夫妇的前瞻性队列进行了一项横断面研究，其中未感染伴侣（性伴侣）感染HIV的唯一风险因素是与感染伴侣（索引病例）的性关系。通过索引伴侣的抗逆转录病毒治疗、索引病例的HIV血浆病毒载量以及性伴侣的性风险暴露情况，比较了入组时性伴侣中的HIV患病率和随访中的血清转化情况。在每次就诊时，对性伴侣进行HIV传播风险评估、预防性咨询和泌尿生殖系统感染筛查，同时确定索引病例的免疫和病毒学状况以及抗逆转录病毒治疗情况。

结果

入组时，在202对索引病例接受HAART的夫妇中未检测到HIV感染。在491对索引病例未接受抗逆转录病毒治疗的夫妇中，性伴侣的HIV患病率为9.6%（p<0.001）。在随访期间，199名索引病例接受HAART的伴侣中没有发生HIV血清转化，累积了7600次危险性性行为暴露和85次自然妊娠。在359对索引病例未接受抗逆转录病毒治疗的夫妇中，记录了超过13000次危险性性行为暴露和5例性伴侣HIV血清转化。当索引病例未接受抗逆转录病毒治疗时，有危险性性行为的夫妇中血清转化百分比为2.5（95%置信区间[CI]：1.1 - 5.6），而当索引病例接受HAART时为零（95%CI：0 - 3.2）。