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International Epidemiology Databases to Evaluate AIDS

Home >> Publications >> Impact of viral load and the duration of primary infection on HIV transmission: systematic review and meta-analysis.

Publication

Author(s):

Blaser N, Wettstein C, Estill J, Vizcaya LS, Wandeler G, Egger M, Keiser O.

Pub Title:

Impact of viral load and the duration of primary infection on HIV transmission: systematic review and meta-analysis.

Pub Date:

Apr 24 2014

Pub Region(s):

Southern Africa

Journal:

Title: 
AIDS
Link: 
http://ovidsp.tx.ovid.com/sp-3.11.0a/ovidweb.cgi?QS2=434f4e1a73d37e8c504983e01e46c99aa269a6408c9ceb4a52ac089d83ba01dc4d95d5564af03b65d67fac36fa85a51027fd7904dc262eebeefc6b9c07e94b22eec10a36fe75f10217e1e7e2cda81450cfda6afebe0fe388a6a50e8f41a601f400fbedcd16

PubMed: 24691205
Pub PDF: PDF icon 24691205.pdf

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 describe 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 higher 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.

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Citation:

Blaser N, Wettstein C, Estill J, Vizcaya LS, Wandeler G, Egger M, Keiser O. Impact of viral load and the duration of primary infection on HIV transmission: systematic review and meta-analysis. AIDS. 2014 Apr 24;28(7):1021-9. doi: 10.1097/QAD.0000000000000135. PubMed PMID: 24691205.