Viral load and heterosexual transmission of human immunodeficiency virus type 1. Rakai Project Study Group
- PMID: 10738050
- DOI: 10.1056/NEJM200003303421303
Viral load and heterosexual transmission of human immunodeficiency virus type 1. Rakai Project Study Group
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 person-years 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 log-transformed 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.
Comment in
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Investigators' responsibilities for human subjects in developing countries.N Engl J Med. 2000 Mar 30;342(13):967-9. doi: 10.1056/NEJM200003303421309. N Engl J Med. 2000. PMID: 10738056 No abstract available.
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Preventing sexual transmission of HIV--new ideas from sub-Saharan Africa.N Engl J Med. 2000 Mar 30;342(13):970-2. doi: 10.1056/NEJM200003303421311. N Engl J Med. 2000. PMID: 10738058 No abstract available.
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The ethics of research in developing countries.N Engl J Med. 2000 Aug 3;343(5):361-2; author reply 363. doi: 10.1056/NEJM200008033430510. N Engl J Med. 2000. PMID: 10928888 No abstract available.
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The ethics of research in developing countries.N Engl J Med. 2000 Aug 3;343(5):362; author reply 363. N Engl J Med. 2000. PMID: 10928890 No abstract available.
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The ethics of research in developing countries.N Engl J Med. 2000 Aug 3;343(5):362-3. N Engl J Med. 2000. PMID: 10928891 No abstract available.
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The ethics of research in developing countries.N Engl J Med. 2000 Aug 3;343(5):363. N Engl J Med. 2000. PMID: 10928892 No abstract available.
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The ethics of research in developing countries.N Engl J Med. 2000 Aug 3;343(5):363. N Engl J Med. 2000. PMID: 10928893 No abstract available.
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A study in rural Uganda of heterosexual transmission of human immunodeficiency virus.N Engl J Med. 2000 Aug 3;343(5):364; author reply 364-5. doi: 10.1056/NEJM200008033430511. N Engl J Med. 2000. PMID: 10928894 No abstract available.
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A study in rural Uganda of heterosexual transmission of human immunodeficiency virus.N Engl J Med. 2000 Aug 3;343(5):364; author reply 364-5. N Engl J Med. 2000. PMID: 10928895 No abstract available.
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