Evidence of zero-risk transmission of HIV in the era of antiretroviral therapy: A systematic review and meta-analyses

IF 3.9 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Public Health Pub Date : 2025-02-01 DOI:10.1016/j.puhe.2024.12.008

Emma Grundtvig Gram , Ida Ege Biering , Ole Olsen , Gregers Jacob Gram

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引用次数: 0

Abstract

Objective

This systematic review aimed to assess the evidence on sexual transmission of HIV in high-income settings between serodiscordant couples where the index partner infected with HIV is on antiretroviral therapy.

Study design

Systematic review and meta-analyses.

Methods

We performed a systematic search in four databases: Embase, MEDLINE, The Cochrane Library, and Web of Science on September 24, 2022. We assessed the risk of bias with ROBINS-I and pooled estimates in meta-analyses using a Poisson regression model with a random effect of the study and population size. The study protocol was pre-registered at PROSPERO. The study involved high-income countries.

Results

The search identified 6886 studies, of which six were included for review. Altogether, studies reported zero linked transmissions among 2383 couples, more than 160,000 acts of intercourse, and 3578 couple years. The risk estimate from overall meta-analyses was 0.000 95%CI (0.000–0.103) per 100 couple-years.

Conclusion

This systematic review and meta-analyses provide epidemiological evidence for a low risk of HIV transmission under antiretroviral therapy in high-income countries and thus cannot reject the theoretical "treatment as prevention" paradigm.

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抗逆转录病毒治疗时代艾滋病毒零风险传播的证据：系统回顾和荟萃分析。

目的：本系统综述旨在评估高收入环境中血清不一致夫妇之间HIV性传播的证据，其中指标伴侣感染HIV正在接受抗逆转录病毒治疗。研究设计：系统评价和荟萃分析。方法：我们于2022年9月24日在Embase、MEDLINE、The Cochrane Library和Web of Science四个数据库中进行了系统检索。我们使用ROBINS-I评估偏倚风险，并在荟萃分析中使用泊松回归模型进行汇总估计，该模型具有研究和人群规模的随机效应。研究方案在普洛斯彼罗预先注册。这项研究涉及高收入国家。结果：检索确定了6886项研究，其中6项纳入了综述。总的来说，研究报告在2383对夫妇、超过16万次性交和3578对夫妇中没有关联传播。总体meta分析的风险估计值为每100对夫妇0.000 95%CI（0.000-0.103）。结论：本系统综述和荟萃分析为高收入国家抗逆转录病毒治疗下艾滋病毒传播风险低提供了流行病学证据，因此不能拒绝“治疗即预防”的理论范式。

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来源期刊

Public Health 医学-公共卫生、环境卫生与职业卫生

CiteScore

7.60

自引率

0.00%

发文量

280

审稿时长

37 days

期刊介绍： Public Health is an international, multidisciplinary peer-reviewed journal. It publishes original papers, reviews and short reports on all aspects of the science, philosophy, and practice of public health.