Laboratory of Clinical and Epidemiological Virology, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, B-3000 Leuven, Belgium.
Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, 1349-008 Lisbon, Portugal.
Viruses. 2022 Mar 5;14(3):538. doi: 10.3390/v14030538.
In the early 1990s, several observational studies determined that genital ulcer disease (GUD), in either the index or the exposed person, facilitates HIV transmission. Several meta-analyses have since presented associated risk ratios (RR) over the baseline per-act transmission probability (PATP) usually in the range of 2-5. Here we review all relevant observational studies and meta-analyses, and show that the estimation of RRs was, in most cases, biased by assuming the presence of GUD at any time during long follow-up periods, while active genital ulcers were present in a small proportion of the time. Only two studies measured the GUD co-factor effect in PATPs focusing on acts in which ulcers were present, and both found much higher RRs (in the range 11-112). We demonstrate that these high RRs can be reconciled with the studies on which currently accepted low RRs were based, if the calculations are restricted to the actual GUD episodes. Our results indicate that the effect of genital ulcers on the PATP of HIV might be much greater than currently accepted. We conclude that the medical community should work on the assumption that HIV risk is very high during active genital ulcers.
在 20 世纪 90 年代早期，几项观察性研究确定生殖器溃疡疾病（GUD），无论是在索引或暴露者中，都会促进 HIV 的传播。此后，几项荟萃分析提出了与基线每次性行为传播概率（PATP）相关的风险比（RR），通常在 2-5 范围内。在这里，我们回顾了所有相关的观察性研究和荟萃分析，并表明在大多数情况下，由于假设在长时间随访期间任何时候都存在 GUD，因此对 RR 的估计存在偏差，而生殖器溃疡仅在一小部分时间存在。只有两项研究在关注存在溃疡的行为时，在 PATPs 中测量了 GUD 协变量的作用，并且都发现了更高的 RR（范围为 11-112）。我们证明，如果将计算仅限于实际的 GUD 发作，这些高 RR 可以与目前基于低 RR 的研究相协调。我们的结果表明，生殖器溃疡对 HIV 的 PATP 的影响可能比目前公认的要大得多。我们的结论是，医学界应该假设在生殖器溃疡活动期间，HIV 风险非常高。
