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Previous Volume 342:921-929 March 30, 2000 Number 13 Next

	Full Text PDF Editorial by Angell, M. Editorial by Cohen, M. S. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

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.

Source Information

From the National Institute of Allergy and Infectious Diseases, Bethesda, Md. (T.C.Q.); Johns Hopkins University, Baltimore (T.C.Q., C.L., R.H.G.); Columbia University, New York (M.J.W., M.O.M.); and the Faculty of Medicine, Makerere University, Kampala, Uganda (N.S., D.S., F.W.-M., T.L.).

Address reprint requests to Dr. Quinn at the Division of Infectious Diseases, Johns Hopkins University, 720 Rutland Ave., Ross 1159, Baltimore, MD 21205-2196.

Full Text of this Article

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A Study in Rural Uganda of Heterosexual Transmission of Human Immunodeficiency Virus
Bailey R. C., Fremont-Smith K., Quinn T. C., Wawer M. J., Sewankambo N. K.
Extract | Full Text  
N Engl J Med 2000; 343:364-365, Aug 3, 2000. Correspondence

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• Kebaabetswe, P, Lockman, S, Mogwe, S, Mandevu, R, Thior, I, Essex, M, Shapiro, R L (2003). Male circumcision: an acceptable strategy for HIV prevention in Botswana. Sex. Transm. Infect. 79: 214-219 [Abstract] [Full Text]  
• Ahdieh-Grant, L., Yamashita, T. E., Phair, J. P., Detels, R., Wolinsky, S. M., Margolick, J. B., Rinaldo, C. R., Jacobson, L. P. (2003). When to Initiate Highly Active Antiretroviral Therapy: A Cohort Approach. Am J Epidemiol 157: 738-746 [Abstract] [Full Text]  
• Montefiori, D. C., Altfeld, M., Lee, P. K., Bilska, M., Zhou, J., Johnston, M. N., Gao, F., Walker, B. D., Rosenberg, E. S. (2003). Viremia Control Despite Escape from a Rapid and Potent Autologous Neutralizing Antibody Response After Therapy Cessation in an HIV-1-Infected Individual. J. Immunol. 170: 3906-3914 [Abstract] [Full Text]  
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• Farmer, P., Gastineau, N. (2002). Rethinking Health and Human Rights: Time for a Paradigm Shift. J Law Med Ethics 30: 655-666  
• DeVange Panteleeff, D., Emery, S., Richardson, B. A., Rousseau, C., Benki, S., Bodrug, S., Kreiss, J. K., Overbaugh, J. (2002). Validation of Performance of the Gen-Probe Human Immunodeficiency Virus Type 1 Viral Load Assay with Genital Swabs and Breast Milk Samples. J. Clin. Microbiol. 40: 3929-3937 [Abstract] [Full Text]