Kaul Rupert, Prodger Jessica, Joag Vineet, Shannon Brett, Yegorov Sergey, Galiwango Ronald, McKinnon Lyle
Departments of Medicine and Immunology, University of Toronto, Medical Sciences Building Rm. 6356, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada,
Curr HIV/AIDS Rep. 2015 Jun;12(2):216-22. doi: 10.1007/s11904-015-0269-5.
While the per-contact risk of sexual HIV transmission is relatively low, it is fourfold higher in sub-Saharan Africa, and this may partly explain the major global disparities that exist in HIV prevalence. Genital immune parameters are key determinants of HIV transmission risk, including epithelial integrity and the presence of highly HIV-susceptible intraepithelial or submucosal CD4+ T cell target cells. Biological parameters that may enhance mucosal HIV susceptibility in highly HIV-affected regions of sub-Saharan Africa include increased levels of mucosal inflammation, which can affect both epithelial integrity and target cell availability, as well as the increased mucosal surface area that is afforded by an intact foreskin, contraceptive choices, and intravaginal practices. There are multifactorial causes for increased mucosal inflammation, with the prevalence and nature of common co-infections being particularly relevant.
虽然每次性接触传播艾滋病毒的风险相对较低，但在撒哈拉以南非洲地区该风险要高出四倍，这可能部分解释了全球艾滋病毒流行率存在的主要差异。生殖器免疫参数是艾滋病毒传播风险的关键决定因素，包括上皮完整性以及上皮内或黏膜下对艾滋病毒高度易感的CD4+T细胞靶细胞的存在。在撒哈拉以南非洲艾滋病毒感染率高的地区，可能增强黏膜对艾滋病毒易感性的生物学参数包括黏膜炎症水平升高，这会影响上皮完整性和靶细胞可用性，以及完整包皮、避孕选择和阴道内性行为所导致的黏膜表面积增加。黏膜炎症增加存在多因素原因，常见合并感染的患病率和性质尤其相关。
