BRIEF - SYNOPSIS OF THE CURRENT EVIDENCE ON THE RISK OF HIV TRANSMISSION.

Abstract

Knowledge of the risk of HIV transmission has evolved over the past decade as evidence on the impact of biological and behavioural co-factors, such as viral load, has come to light. We undertook a comprehensive review of the evidence on the risk of HIV transmission. A search was conducted for literature published between January 2001 and May 2012. The search focused on systematic, meta-analytic, and narrative reviews. For topics where no reviews existed, primary research studies were included. The risk estimates for the sexual transmission of HIV, per sex act, ranged from 0.5% to 3.38% (with mid-range estimates of 1.4% to 1.69%) for receptive anal intercourse; 0.06% to 0.16% for insertive anal intercourse; 0.08% to 0.19% for receptive vaginal intercourse; and approximately 0.05% to 0.1% for insertive vaginal intercourse. For people who inject drugs, the risk of transmission from a contaminated needle, per injection, was estimated to be between 0.7% and 0.8%. A number of factors impact the risk, including viral load, the presence of other sexually transmitted infections (STIs), and male circumcision. Within each route of transmission, estimates of the risk of transmission varied widely, likely due to the role of behavioural and biological co-factors. Viral load appears to be an important predictor of transmission, regardless of the route of transmission. However, the evidence indicates that viral load is not the only determinant and that certain co-factors play a role in increasing (e.g., STIs) or decreasing (e.g., male circumcision) the risk of transmission.