Absence of Transmission from HIV-Infected Individuals with HAART to Their Heterosexual Serodiscordant Partners
BACKGROUND:
Further
studies are needed to evaluate the level of effectiveness and durability of
HAART to reduce the risk of HIV sexual transmission in serodiscordant couples
having unprotected sexual practices.
METHODS:
A
cross-sectional study was conducted with prospective cohort of heterosexual HIV
serodiscordant couples where the only risk factor for HIV transmission to the
uninfected partner (sexual partner) was the sexual relationship with the
infected partner (index case). HIV prevalence in sexual partners at enrolment
and seroconversions in follow-up were compared by antiretroviral treatment in
the index partner, HIV plasma viral load in index cases and sexual risk
exposures in sexual partners. In each visit, an evaluation of the risks for HIV
transmission, preventive counselling and screening for genitourinary infections
in the sexual partner was performed, as well as the determination of the
immunological and virological situation and antiretroviral treatment in the
index case.
RESULTS:
At
enrolment no HIV infection was detected in 202 couples where the index case was
taking HAART. HIV prevalence in sexual partners was 9.6% in 491 couples where
the index case was not taking antiretroviral treatment (p<0.001). During
follow-up there was no HIV seroconversion among 199 partners whose index case
was taking HAART, accruing 7600 risky sexual exposures and 85 natural
pregnancies. Among 359 couples whose index case was not under antiretroviral
treatment, over 13,000 risky sexual exposures and 5 HIV seroconversions of sexual
partners were recorded. The percentage of seroconversion among couples having
risky sexual intercourse was 2.5 (95% confidence interval [CI]: 1.1-5.6) when
the index case did not undergo antiretroviral treatment and zero (95% CI:
0-3.2) when the index case received HAART.
CONCLUSIONS:
The
risk of sexual transmission of HIV from individuals with HAART to their
heterosexual partners can become extremely low.
- 1Centro Sanitario Sandoval, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain. Electronic address: jromero@salud.madrid.org.
- 2CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Centro Nacional de Epidemiología, Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
- 3Instituto de Salud Pública de Navarra, Pamplona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain.
- 4Centro Sanitario Sandoval, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain.
- 5Centro Nacional de Epidemiología, Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
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