Abstract
BackgroundConsistent and correct condom use and suppressive antiretroviral therapy for the infected partner are two of the primary strategies recommended for prevention of heterosexual HIV transmission in serodiscordant couples today. The applied effectiveness of treatment as a prevention strategy in China is still under investigation, and much less is known about its effects in the presence of other prevention strategies such as consistent condom use.MethodsWe conducted a systematic search in PubMed and three Chinese language databases to identify relevant articles for the estimation of relative effectiveness of a) consistent condom use and b) ART use by index partners for preventing HIV transmission in serodiscordant couples. We also estimated the prevention effectiveness of ART stratified by condom use level and the prevention effectiveness of consistent condom use stratified by ART use level.ResultsPooled results from the eleven eligible studies found a pooled HIV seroconversion incidence of 0.92 cases per 100 person years (PY) among HIV-negative spouses whose index partners were taking ART versus 2.45 cases per 100 PY in untreated couples. The IRR comparing seroconversion in couples where the index-partner was on ART versus not on ART was 0.47 (95%CI: 0.43, 0.52), while stratified by condom use, the IRR was 0.33(0.17,0.64). The IRR comparing incidence in couples reporting “consistent condom use” versus those reporting otherwise was 0.02(95%CI:0.01,0.04), after stratified by ART use level, the IRR was 0.01(95%CI: 0.00, 0.06).ConclusionsART use by index partners could reduce HIV transmission in serodiscordant couples, and the effectiveness of this prevention strategy could be further increased with consistent condom use.
Highlights
The probability of HIV transmission through sexual intercourse is broadly associated with factors including type of sexual intercourse [1], infection stage of the infected partner [2], susceptibility of the uninfected partner [2,3] and viral load in genital secretions of the infected person [4,5]
Pooled incidence rates of HIV-1 seroconversion Among couples whose index partners were on Antiretroviral treatment (ART), the pooled
Our meta-analysis found out that the pooled HIV-1 seroconversion incidence rate estimates were lowest in the serodiscordant couples with consistent condom use, the crude IRR was 0.02(95%CI: 0.01,0.04) for consistent condom use versus not consistent condom use group, while a 53% reduction (95%CI: 48%, 57%) in HIV-1 sexual transmission with ART use by the index-partner from ART-stratified studies
Summary
The probability of HIV transmission through sexual intercourse is broadly associated with factors including type of sexual intercourse [1], infection stage of the infected partner [2], susceptibility of the uninfected partner [2,3] and viral load in genital secretions of the infected person [4,5]. Antiretroviral treatment (ART) to suppress seminal and vaginal HIV-1 shedding [8,9] has long been hypothesized to explain the lower rates of transmission in treated HIV serodiscordant couples (in which only one partner is HIV infected) [10,11], populations with higher ART coverage[12,13,14], and through mathematic models [15,16,17]. A better understanding of the effectiveness of these two prevention methods in a population of HIV serodiscordant couples can provide much needed insight into prevention programming and counseling in similar settings. Consistent and correct condom use and suppressive antiretroviral therapy for the infected partner are two of the primary strategies recommended for prevention of heterosexual HIV transmission in serodiscordant couples today. The applied effectiveness of treatment as a prevention strategy in China is still under investigation, and much less is known about its effects in the presence of other prevention strategies such as consistent condom use
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