世界卫生组织Lara Vojnov团队对典型个体的性传播艾滋病毒的风险进行了系统回顾。该项研究成果发表在2023年7月22日出版的《柳叶刀》杂志上。

接受抗逆转录病毒治疗的低水平艾滋病毒血症患者性传播艾滋病毒的风险对公共卫生有重要影响，尤其是在使用血浆病毒载量检测替代品的资源有限的环境中。研究组总结了与不同HIV病毒载量水平的HIV性传播相关的证据，为HIV感染者、其伴侣、其医疗保健提供者和广大公众提供信息。

研究组对PubMed、MEDLINE、Cochrane Central Register of Controlled Trials、Embase、Conference Proceedings Citation Index-Science和世界卫生组织Global Index Medicus等大型数据库从2010年1月1日至2022年11月17日发表的工作进行了系统回顾和检索。如果研究涉及不同水平病毒血症的血清不一致夫妇之间的性传播，无法检测等同于不可传播，或低水平病毒血症对公共健康的影响，则纳入研究。如果研究没有指定病毒载量阈值或低水平病毒血症的定义，或者没有提供传播结果的定量病毒载量信息，则将其排除在外。不包括评论、非研究信件、评论和社论。使用ROBINS-I框架评估偏倚风险。提取并总结了数据，重点是不同HIV病毒载量下的HIV性传播。

共确定了244项研究，其中8项被纳入分析，包括25个国家的7762对血清不一致夫妇。证据的确定性是适度的；出现偏倚的风险很低。三项研究表明，当感染艾滋病毒的伴侣的病毒载量低于每毫升200个拷贝时，没有艾滋病毒传播。在剩下的四项前瞻性研究中，有323起传播事件；在被认为抗逆转录病毒疗法稳定抑制的患者中没有一例。在所有研究中，当指标患者（即先前诊断为HIV感染的患者）的最新病毒载量低于每毫升1000个拷贝时，有两例传播病例。然而，由于传播日期和最新指标病毒载量结果之间的间隔很长（即50天和53天），这两例病例的解释都很复杂。

研究结果表明，病毒载量低于每毫升1000个拷贝的艾滋病毒性传播风险几乎为零。这些数据为消除艾滋病毒的污名化和通过传播这一积极的公共卫生信息促进对抗逆转录病毒疗法的坚持提供了强有力的机会。该发现还可以通过促进替代样本类型和技术的使用，促进所有艾滋病毒感染者在资源有限的环境中进行病毒载量检测。

附：英文原文

Title: The risk of sexual transmission of HIV in individuals with low-level HIV viraemia: a systematic review

Author: Laura N Broyles, Robert Luo, Debi Boeras, Lara Vojnov

Issue&Volume: 2023-07-22

Abstract:

Background

The risk of sexual transmission of HIV from individuals with low-level HIV viraemia receiving antiretroviral therapy (ART) has important public health implications, especially in resource-limited settings that use alternatives to plasma-based viral load testing. This Article summarises the evidence related to sexual transmission of HIV at varying HIV viral load levels to inform messaging for people living with HIV, their partners, their health-care providers, and the wider public.

Methods

We conducted a systematic review and searched PubMed, MEDLINE, Cochrane Central Register of Controlled Trials, Embase, Conference Proceedings Citation Index-Science, and WHO Global Index Medicus, for work published from Jan 1, 2010 to Nov 17, 2022. Studies were included if they pertained to sexual transmission between serodiscordant couples at various levels of viraemia, the science behind undetectable=untransmittable, or the public health impact of low-level viraemia. Studies were excluded if they did not specify viral load thresholds or a definition for low-level viraemia or did not provide quantitative viral load information for transmission outcomes. Reviews, non-research letters, commentaries, and editorials were excluded. Risk of bias was evaluated using the ROBINS-I framework. Data were extracted and summarised with a focus on HIV sexual transmission at varying HIV viral loads.

Findings

244 studies were identified and eight were included in the analysis, comprising 7762 serodiscordant couples across 25 countries. The certainty of evidence was moderate; the risk of bias was low. Three studies showed no HIV transmission when the partner living with HIV had a viral load less than 200 copies per mL. Across the remaining four prospective studies, there were 323 transmission events; none were in patients considered stably suppressed on ART. Among all studies there were two cases of transmission when the index patient's (ie, patient with previously diagnosed HIV infection) most recent viral load was less than 1000 copies per mL. However, interpretation of both cases was complicated by long intervals (ie, 50 days and 53 days) between the transmission date and the most recent index viral load result.

Interpretation

There is almost zero risk of sexual transmission of HIV with viral loads of less than 1000 copies per mL. These data provide a powerful opportunity to destigmatise HIV and promote adherence to ART through dissemination of this positive public health message. These findings can also promote access to viral load testing in resource-limited settings for all people living with HIV by facilitating uptake of alternative sample types and technologies.

DOI: 10.1016/S0140-6736(23)00877-2

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00877-2/fulltext