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Does per-act HIV-1 transmission risk through anal sex vary by gender? An updated systematic review and meta-analysis

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Title: Does per-act HIV-1 transmission risk through anal sex vary by gender? An updated systematic review and meta-analysis
Authors: Baggaley, R
Owen, B
Silhol, R
Elmes, J
Anton, P
McGowan, I
Van der Straten, A
Shacklett, B
Dang, Q
Swann, EM
Bolton, DL
Boily, MC
Item Type: Journal Article
Abstract: Quantifying HIV‐1 transmission risk per‐act of anal intercourse (AI) is important for HIV‐1 prevention. We updated previous reviews by searching Medline and Embase to 02/2018. We derived pooled estimates of receptive AI (URAI) and insertive AI (UIAI) risk unprotected by condoms using random‐effects models. Subgroup analyses were conducted by gender, study design, and whether antiretroviral treatment (ART) had been introduced by the time of the study. Two new relevant studies were identified, one of which met inclusion criteria, adding three new cohorts and increasing number of individuals/partnerships included from 1869 to 14 277. Four studies, all from high‐income countries, were included. Pooled HIV‐1 risk was higher for URAI (1.25%, 95% CI 0.55%‐2.23%, N = 5, I2 = 87%) than UIAI (0.17%, 95 % CI 0.09%‐0.26%, N = 3, I2 = 0%). The sole heterosexual URAI estimate (3.38%, 95% CI 1.85%‐4.91%), from a study of 72 women published in a peer‐reviewed journal, was significantly higher than the men‐who‐have‐sex‐with‐men (MSM) pooled estimate (0.75%, 95% CI 0.56%‐0.98%, N = 4, P < 0.0001) and higher than the only other heterosexual estimate identified (0.4%, 95% CI 0.08%‐2.0%, based on 59 women, excluded for being a pre‐2013 abstract). Pooled per‐act URAI risk varied by study design (retrospective‐partner studies: 2.56%, 95% CI 1.20%‐4.42%, N = 2 (one MSM, one heterosexual); prospective studies: 0.71%, 95% CI 0.51%‐0.93%, N = 3 MSM, P < 0.0001). URAI risk was lower for studies conducted in the ART era (0.75%, 95% CI 0.52%‐1.03%) than pre‐ART (1.67%, 95% CI 0.44%‐3.67%) but not significantly so (P = 0.537). Prevention messages must emphasize that HIV‐1 infectiousness through AI remains high, even in the ART era. Further studies, particularly among heterosexual populations and in resource‐limited settings, are required to elucidate whether AI risk differs by gender, region and following population‐level ART scale‐up.
Issue Date: 1-Nov-2018
Date of Acceptance: 31-Jul-2018
URI: http://hdl.handle.net/10044/1/62686
DOI: https://dx.doi.org/10.1111/aji.13039
ISSN: 1046-7408
Publisher: Wiley
Journal / Book Title: American Journal of Reproductive Immunology
Volume: 80
Issue: 5
Copyright Statement: © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. This is the pre-peer reviewed version of the following article, which has been published in final form at https://onlinelibrary.wiley.com/doi/abs/10.1111/aji.13039
Sponsor/Funder: National Institutes of Health
Medical Research Council (MRC)
Funder's Grant Number: 5R01AI057020 Sub#201224310-05
MR/R015600/1
Keywords: Science & Technology
Life Sciences & Biomedicine
Immunology
Reproductive Biology
anal intercourse
antiretroviral therapy
heterosexual
HIV
infectivity
meta-analysis
MSM
review
transmission probability
HUMAN-IMMUNODEFICIENCY-VIRUS
DEVELOPING-COUNTRIES
HOMOSEXUAL-MEN
UNITED-STATES
INTERCOURSE
PREVENTION
INFECTION
VACCINE
PARTNERS
TRIALS
HIV
MSM
anal intercourse
antiretroviral therapy
heterosexual
infectivity
meta-analysis
review
transmission probability
Obstetrics & Reproductive Medicine
1107 Immunology
1114 Paediatrics and Reproductive Medicine
1103 Clinical Sciences
Publication Status: Published
Article Number: e13039
Online Publication Date: 2018-09-02
Appears in Collections:School of Public Health