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Cited by 748HIV/AIDS Research and InterventionsHIV, Drug Use, Sexual RiskHIV Research and Treatment

Estimating per-act HIV transmission risk: a systematic review

Open access
Patel, Pragna, Borkowf, Craig B., Brooks, John T., Lasry, Arielle, Lansky, Amy, Mermin, Jonathan·2014·AIDS
DOI 10.1097/qad.0000000000000298PMC PMC6195215
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Abstract

BACKGROUND: Effective HIV prevention programs rely on accurate estimates of the per-act risk of HIV acquisition from sexual and parenteral exposures. We updated the previous risk estimates of HIV acquisition from parenteral, vertical, and sexual exposures, and assessed the modifying effects of factors including condom use, male circumcision, and antiretroviral therapy. METHODS: We conducted literature searches to identify new studies reporting data regarding per-act HIV transmission risk and modifying factors. Of the 7339 abstracts potentially related to per-act HIV transmission risk, three meta-analyses provided pooled per-act transmission risk probabilities and two studies provided data on modifying factors. Of the 8119 abstracts related to modifying factors, 15 relevant articles, including three meta-analyses, were included. We used fixed-effects inverse-variance models on the logarithmic scale to obtain updated estimates of certain transmission risks using data from primary studies, and employed Poisson regression to calculate relative risks with exact 95% confidence intervals for certain modifying factors. RESULTS: Risk of HIV transmission was greatest for blood transfusion, followed by vertical exposure, sexual exposures, and other parenteral exposures. Sexual exposure risks ranged from low for oral sex to 138 infections per 10,000 exposures for receptive anal intercourse. Estimated risks of HIV acquisition from sexual exposure were attenuated by 99.2% with the dual use of condoms and antiretroviral treatment of the HIV-infected partner. CONCLUSION: The risk of HIV acquisition varied widely, and the estimates for receptive anal intercourse increased compared with previous estimates. The risk associated with sexual intercourse was reduced most substantially by the combined use of condoms and antiretroviral treatment of HIV-infected partners.

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Crossref · 10.1097/qad.0000000000000298

Cites

75 of 75 references verified0 citation errors · 0 not checkable

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  • In consensual sex, the per-act risk for HIV transmission from vaginal intercourse is 0.08%, and for receptive anal intercourse, 1.38%.

    “In consensual sex, the per-act risk for HIV transmission from vaginal intercourse is 0.08%, and for receptive anal intercourse, 1.38% (192).”

    From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [192]

    The Results section, “Summary of HIV transmission risk estimates,” gives 138 per 10,000 exposures (1.38%) for receptive anal intercourse and 8 per 10,000 (0.08%) for receptive penile–vaginal intercourse. The claim omits “receptive” for vaginal intercourse; the paper gives a different estimate, 4 per 10,000 (0.04%), for insertive penile–vaginal intercourse. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • For HIV, transmission occurs much more readily through receptive anal sex, compared with penile-vaginal sex.

    “For HIV, transmission occurs much more readily through receptive anal sex, compared with penile-vaginal sex (192).”

    From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [192]

  • The per-act risk for HIV transmission from oral sex is substantially lower.

    “The per-act risk for HIV transmission from oral sex is substantially lower.”

    From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [192]

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Cites

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Research works printed but not linked: 7

  1. [35]Jorbeck H Steinkeller E 41 cases of accidental infection with HIV-positive blood (in Swedish) Lakartidningen 1988 85 3044 3045 3199942
  2. [36]Jorbeck H Marland M Steinkeller E Accidental exposures to HIV-positive blood among health-care workers in 2 Swedish hospitals Fifth International Conference on AIDS Montreal, Quebec, Canada 1989 [Abstract A517]
  3. [43]Cavalcante NJ Richtmann R Abreu ES Ramalho MO Piovesana MN Carvalho ES Changing of notifications of accidents with HIV infective materials, among healthcare professionals (HCP) at Emilio Ribas Institute, Sao Paolo, Brazil IX International Conference on AIDS Berlin June 1993 [abstract PO-C18-3030]
  4. [45]Ippolito G De Carli G Puro V Petrosillo N (SIROH) SIROdH Risk of occupational HIV and HCV infection after occupational exposure XI International Conference on AIDS Vancouver July 1996 [abstract TuC123]
  5. [47]Cardo D Tokars J Marcus R McKibben P Culver D Ciesielski C Bell D Cooperative Needlestick Group Zidovudine (AZT) use after occupational HIV exposure: toxicity and failures reported to CDC; an update [Abstract] Conference on Prevention of Transmission of Bloodborne Pathogens in Surgery and Obstetrics Atlanta Infect Control Hosp Epidemiol 1994 15 342
  6. [49]de Juanes JR Lago E Davila F Aragon AJ Arrazola P Garcia Codes A Injuries with exposure to blood in surgeons of a university hospital, over a year period Abstract Conference on prevention of transmission of bloodborne pathogens in surgery and obstetrics Atlanta Infect Control Hosp Epidemiol 1994 15 343
  7. [56]Longini IM Scott Clark W Haber M Horsburgh R Jr The stages of HIV infection: waiting times and infection transmission probabilities Castillo-Chavez C Mathematical and statistical approaches to AIDS epidemiology Berlin Springer-Verlag 1989 111 137

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Authors
Patel, P., Borkowf, C. B., Brooks, J. T., Lasry, A., Lansky, A., & Mermin, J.
Affiliations
Centers for Disease Control and Prevention (US)
Corresponding author
Patel, Pragna
ORCID
Venue
AIDS
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2014-06-19
Volume
28
Issue
10
Pages
1509-1519
ISSN
0269-9370 (ISSN-L)
DOI
10.1097/qad.0000000000000298
PMC
PMC6195215
OpenAlex
W2134269809
Cited by
748
References
75
Citations by year
2026: 38 · 2025: 41 · 2024: 39 · 2023: 56 · 2022: 63 · 2021: 74 · 2020: 84 · 2019: 79 · 2018: 89 · 2017: 60 · 2016: 65 · 2015: 51 · 2014: 9
FWCI
8.56
Type
journal article
Language
en
Open access
Locations
  • AIDS (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institutes of Health (CC999999)
Topics
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
  • Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
  • Life Sciences › Immunology and Microbiology › Virology › HIV Research and Treatment
Keywords
HIV risk factors, sexual transmission, blood-borne transmission, vertical transmission, blood transfusion, receptive anal intercourse, oral sex, condom use, male circumcision, antiretroviral therapy, HIV prevention
MeSH terms
Humans, Iatrogenic Disease, Mother-Child Relations, Sexual Behavior, HIV Infections, Infectious Disease Transmission, Vertical, Disease Transmission, Infectious, Risk Assessment

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