TY - JOUR
T1 - Rates of HIV-1 transmission per coital act, by stage of HIV-1 infection, in Rakai, Uganda
AU - Wawer, Maria J.
AU - Gray, Ronald H.
AU - Sewankambo, Nelson K.
AU - Serwadda, David
AU - Li, Xianbin
AU - Laeyendecker, Oliver
AU - Kiwanuka, Noah
AU - Kigozi, Godfrey
AU - Kiddugavu, Mohammed
AU - Lutalo, Thomas
AU - Nalugoda, Fred
AU - Wabwire-Mangen, Fred
AU - Meehan, Mary P.
AU - Quinn, Thomas C.
N1 - Funding Information:
Financial support: National Institute of Allergy and Infectious Diseases (grant R01 AI34826); National Institute of Child Health and Development (grant 5P30HDS06826); Fogarty Foundation (grant 5D43W00010); US National Institutes of Health; World Bank Uganda STI Project.
PY - 2005/5/1
Y1 - 2005/5/1
N2 - Background. We estimated rates of human immunodeficiency virus (HIV)-1 transmission per coital act in HIV-discordant couples by stage of infection in the index partner. Methods. We retrospectively identified 235 monogamous, HIV-discordant couples in a Ugandan population-based cohort. HIV transmission within pairs was confirmed by sequence analysis. Rates of transmission per coital act were estimated by the index partner's stage of infection (recent seroconversion or prevalent or late-stage infection). The adjusted rate ratio of transmission per coital act was estimated by multivariate Poisson regression. Results. The average rate of HIV transmission was 0.0082/coital act (95% confidence interval [CI], 0.0039-0.0150) within ∼2.5 months after seroconversion of the index partner; 0.0015/coital act within 6-15 months after seroconversion of the index partner (95% CI, 0.0002-0.0055); 0.0007/coital act (95% CI, 0.0005-0.0010) among HIV-prevalent index partners; and 0.0028/coital act (95% CI, 0.0015-0.0041) 6-25 months before the death of the index partner. In adjusted models, early- and late-stage infection, higher HIV load, genital ulcer disease, and younger age of the index partner were significantly associated with higher rates of transmission. Conclusions. The rate of HIV transmission per coital act was highest during early-stage infection. This has implications for HIV prevention and for projecting the effects of antiretroviral treatment on HIV transmission.
AB - Background. We estimated rates of human immunodeficiency virus (HIV)-1 transmission per coital act in HIV-discordant couples by stage of infection in the index partner. Methods. We retrospectively identified 235 monogamous, HIV-discordant couples in a Ugandan population-based cohort. HIV transmission within pairs was confirmed by sequence analysis. Rates of transmission per coital act were estimated by the index partner's stage of infection (recent seroconversion or prevalent or late-stage infection). The adjusted rate ratio of transmission per coital act was estimated by multivariate Poisson regression. Results. The average rate of HIV transmission was 0.0082/coital act (95% confidence interval [CI], 0.0039-0.0150) within ∼2.5 months after seroconversion of the index partner; 0.0015/coital act within 6-15 months after seroconversion of the index partner (95% CI, 0.0002-0.0055); 0.0007/coital act (95% CI, 0.0005-0.0010) among HIV-prevalent index partners; and 0.0028/coital act (95% CI, 0.0015-0.0041) 6-25 months before the death of the index partner. In adjusted models, early- and late-stage infection, higher HIV load, genital ulcer disease, and younger age of the index partner were significantly associated with higher rates of transmission. Conclusions. The rate of HIV transmission per coital act was highest during early-stage infection. This has implications for HIV prevention and for projecting the effects of antiretroviral treatment on HIV transmission.
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U2 - 10.1086/429411
DO - 10.1086/429411
M3 - Article
C2 - 15809897
AN - SCOPUS:20244368227
SN - 0022-1899
VL - 191
SP - 1403
EP - 1409
JO - Journal of Infectious Diseases
JF - Journal of Infectious Diseases
IS - 9
ER -