Impact of viral load and the duration of primary infection on HIV transmission

Blaser, Nello; Wettstein, Celina; Estill, Janne Anton Markus; Vizcaya, Luisa Salazar; Wandeler, Gilles; Egger, Matthias; Keiser, Olivia (2014). Impact of viral load and the duration of primary infection on HIV transmission. AIDS, 28(7), pp. 1021-1029. Lippincott Williams & Wilkins 10.1097/QAD.0000000000000135

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Abstract Objectives: HIV 'treatment as prevention' (TasP) describes early treatment of HIV-infected patients intended to reduce viral load and transmission. Crucial assumptions for estimating TasP's effectiveness are the underlying estimates of transmission risk. We aimed to determine transmission risk during primary infection, and of the relation of HIV transmission risk to viral load. Design: A systematic review and meta-analysis. Methods: We searched PubMed and Embase databases for studies that established a relationship between viral load and transmission risk, or primary infection and transmission risk, in serodiscordant couples. We analysed assumptions about the relationship between viral load and transmission risk, and between duration of primary infection and transmission risk. Results: We found 36 eligible articles, based on six different study populations. Studies consistently found that larger viral loads lead to higher HIV transmission rates, but assumptions about the shape of this increase varied from exponential increase to saturation. The assumed duration of primary infection ranged from 1.5 to 12 months; for each additional month, the log10 transmission rate ratio between primary and asymptomatic infection decreased by 0.40. Conclusion: Assumptions and estimates of the relationship between viral load and transmission risk, and the relationship between primary infection and transmission risk, vary substantially and predictions of TasP's effectiveness should take this uncertainty into account.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology

UniBE Contributor:

Blaser, Nello; Wettstein, Celina; Estill, Janne Anton Markus; Salazar, Luisa Paola; Wandeler, Gilles; Egger, Matthias and Keiser, Olivia

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0269-9370

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

12 Sep 2014 08:47

Last Modified:

21 Oct 2015 12:03

Publisher DOI:

10.1097/QAD.0000000000000135

PubMed ID:

24691205

Uncontrolled Keywords:

Acute disease, HIV, primary infection, systematic review, transmission, treatment as prevention, viral load

BORIS DOI:

10.7892/boris.48425

URI:

https://boris.unibe.ch/id/eprint/48425

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