Viral load and heterosexual transmission of human immunodeficiency virus type 1
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Date
2000
Journal Title
Journal ISSN
Volume Title
Publisher
New England journal of medicine
Abstract
Background and Methods We examined the influence of viral load in relation to other risk factors for
the heterosexual transmission of human immunodeficiency virus type 1 (HIV-1). In a community-based
study of 15,127 persons in a rural district of Uganda,
we identified 415 couples in which one partner was
HIV-1–positive and one was initially HIV-1–negative
and followed them prospectively for up to 30 months.
The incidence of HIV-1 infection per 100 person-years
among the initially seronegative partners was examined in relation to behavioral and biologic variables.
Results The male partner was HIV-1–positive in
228 couples, and the female partner was HIV-1–positive in 187 couples. Ninety of the 415 initially HIV-1–
negative partners seroconverted (incidence, 11.8 per
100 person-years). The rate of male-to-female transmission was not significantly different from the rate
of female-to-male transmission (12.0 per 100 personyears vs. 11.6 per 100 person-years). The incidence of
seroconversion was highest among the partners who
were 15 to 19 years of age (15.3 per 100 person-years).
The incidence was 16.7 per 100 person-years among
137 uncircumcised male partners, whereas there were
no seroconversions among the 50 circumcised male
partners (P<0.001). The mean serum HIV-1 RNA level
was significantly higher among HIV-1–positive subjects whose partners seroconverted than among those
whose partners did not seroconvert (90,254 copies
per milliliter vs. 38,029 copies per milliliter, P=0.01).
There were no instances of transmission among the
51 subjects with serum HIV-1 RNA levels of less than
1500 copies per milliliter; there was a significant dose–
response relation of increased transmission with increasing viral load. In multivariate analyses of logtransformed HIV-1 RNA levels, each log increment in
the viral load was associated with a rate ratio of 2.45
for seroconversion (95 percent confidence interval,
1.85 to 3.26).
Conclusions The viral load is the chief predictor of
the risk of heterosexual transmission of HIV-1, and
transmission is rare among persons with levels of less
than 1500 copies of HIV-1 RNA per milliliter. (N Engl
J Med 2000;342:921-9.)
©2000, Massachusetts Medical Society.
Description
Keywords
Viral load, Heterosexual transmission, Human immunodeficiency virus Type 1
Citation
Quinn, T. C., Wawer, M. J., Sewankambo, N., Serwadda, D., Li, C., Wabwire-Mangen, F., ... & Gray, R. H. (2000). Viral load and heterosexual transmission of human immunodeficiency virus type 1. New England journal of medicine, 342(13), 921-929.