de Vincenzi I
European Centre for the Epidemiological Monitoring of AIDS, Hôpital National de Saint-Maurice, France.
N Engl J Med. 1994 Aug 11;331(6):341-6. doi: 10.1056/NEJM199408113310601.
Worldwide, the predominant mode of human immunodeficiency virus (HIV) transmission is heterosexual intercourse, but the risk of heterosexual transmission and the effectiveness of measures to prevent it are not well defined.
We conducted a prospective study of HIV-negative subjects whose only risk of HIV infection was a stable heterosexual relationship with an HIV-infected partner. Every six months the subjects were interviewed, tested for HIV, and counseled about safe sexual practices.
A total of 304 HIV-negative subjects (196 women and 108 men) were followed for an average of 20 months. During the study, 130 couples (42.8 percent) ended their sexual relationships, most often because of the HIV-infected partner's illness or death. Of the 256 couples who continued to have sexual relations for more than three months after enrollment in the study, only 124 (48.4 percent) used condoms consistently for vaginal and anal intercourse. Among these couples, none of the seronegative partners became infected with HIV, despite a total of about 15,000 episodes of intercourse. Among the 121 couples who used condoms inconsistently, the rate of seroconversion was 4.8 per 100 person-years (95 percent confidence interval, 2.5 to 8.4). Eleven couples refused to answer questions about condom use. The risk of transmission increased with advanced stages of HIV infection in the index partners (P < 0.02) and with genital infection in the HIV-negative partners (P < 0.04). Withdrawal to avoid ejaculation in the vagina had a protective effect in uninfected women (P < 0.02).
Consistent use of condoms for heterosexual intercourse is highly effective in preventing the transmission of HIV. Among couples not using condoms regularly, the risk of HIV transmission varies widely.
在全球范围内，人类免疫缺陷病毒（HIV）传播的主要方式是异性性行为，但异性传播的风险以及预防措施的有效性尚未明确界定。
我们对HIV阴性受试者进行了一项前瞻性研究，这些受试者感染HIV的唯一风险是与一名感染HIV的伴侣保持稳定的异性关系。每六个月对受试者进行访谈、检测HIV，并就安全性行为提供咨询。
总共304名HIV阴性受试者（196名女性和108名男性）平均随访了20个月。在研究期间，130对伴侣（42.8%）结束了他们的性关系，最常见的原因是感染HIV的伴侣患病或死亡。在研究入组后持续发生性关系超过三个月的256对伴侣中，只有124对（48.4%）在阴道和肛门性交时始终使用避孕套。在这些伴侣中，血清阴性的伴侣均未感染HIV，尽管性交次数总计约15000次。在121对未始终使用避孕套的伴侣中，血清转化发生率为每100人年4.8例（95%置信区间，2.5至8.4）。11对伴侣拒绝回答有关避孕套使用的问题。传播风险随着指数伴侣HIV感染阶段的进展而增加（P<0.02），并且随着HIV阴性伴侣的生殖器感染而增加（P<0.04）。在未感染的女性中，抽出阴茎以避免在阴道内射精具有保护作用（P<0.02）。
异性性交时始终使用避孕套在预防HIV传播方面非常有效。在未定期使用避孕套的伴侣中，HIV传播风险差异很大。
