Brief Report: Per Sex-Act Risk of HIV Transmission Under Antiretroviral Treatment: A Data-Driven Approach
| Autor: | Virginie Supervie, Romulus Breban |
|---|---|
| Přispěvatelé: | Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Epidémiologie des Maladies Emergentes - Emerging Diseases Epidemiology, Pasteur-Cnam Risques infectieux et émergents (PACRI), Institut Pasteur [Paris] (IP)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Institut Pasteur [Paris] (IP)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM) |
| Rok vydání: | 2018 |
| Předmět: |
0301 basic medicine
Cart HPTN 052 Male [SDV]Life Sciences [q-bio] HIV Infections Risk Assessment Men who have sex with men 03 medical and health sciences 0302 clinical medicine Disease Transmission Infectious Medicine Humans Pharmacology (medical) 030212 general & internal medicine Seroconversion Models Statistical business.industry virus diseases Viral Load 030112 virology Bayesian statistics Infectious Diseases Anti-Retroviral Agents Serodiscordant Female Risk assessment business Viral load Demography |
| Zdroj: | Journal of Acquired Immune Deficiency Syndromes-JAIDS Journal of Acquired Immune Deficiency Syndromes-JAIDS, 2018, 79 (4), pp.440--444. ⟨10.1097/QAI.0000000000001845⟩ |
| ISSN: | 1944-7884 1525-4135 |
| DOI: | 10.1097/QAI.0000000000001845⟩ |
| Popis: | International audience; Background: Before the completion of HPTN 052, PARTNER, and Opposites Attract studies, data were lacking to directly estimate HIV transmission risk under effective combined antiretroviral treatment (cART). Rather, estimates were obtained by extrapolating a dose-response relationship between viral load and risk of HIV transmission, observed among untreated individuals, to treated individuals. Presently, data have accumulated from 9 clinical studies for a direct validation of this extrapolation.Methods: Using estimates of per sex-act risk of HIV transmission on effective cART obtained by extrapolation, sexual behavior data, and a simple mathematical model, we estimated the number of seroconversions that should have been observed in HIV-serodiscordant couples where the HIV-positive partner was on cART across the 9 studies. We compared this with the number of seroconversions actually observed. Next, we directly estimated the risk of HIV transmission on effective cART, using Bayesian statistics to combine all available data.Results: We found that at least 4.7 (uncertainty bounds: 1.7-12.6) and 35.1 (uncertainty bounds: 13.2-92.0) seroconversions should have been observed among, respectively, heterosexual and men who have sex with men (MSM) serodiscordant couples. This is not validated by observations across the studies, which reported at most 1 seroconversion among heterosexual couples and 0 for MSM. Combining all available data, we found that the maximum per sex-act risk of HIV transmission under effective cART is 3.9:100,000 for heterosexuals and 4.4:100,000 for MSM.Conclusions: Data have accumulated to render obsolete estimates of the risk of HIV transmission on cART obtained by extrapolation. Direct estimates are substantially lower and should be used in practice. |
| Databáze: | OpenAIRE |
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