Hola Doctor! un placer contactarme con Ud dada su franqueza y simpleza de respuestas. en este caso me gustaria saber su opinion sobre este articulo que encontré en la pagina medscape: Viral Load and Heterosexual Transmission of Human Immunodeficiency Virus Type 1

Thomas C. Quinn, M.D., Maria J. Wawer, M.D., Nelson Sewankambo, M.B., David Serwadda, M.B., Chuanjun Li, M.D., Fred Wabwire-Mangen, Ph.D., Mary O. Meehan, B.S., Thomas Lutalo, M.A., Ronald H. Gray, M.D., for The Rakai Project Study Group

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

Find Similar Articles 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-1positive and one was initially HIV-1negative 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-1positive in 228 couples, and the female partner was HIV-1positive in 187 couples. Ninety of the 415 initially HIV-1negative 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-1positive 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 doseresponse 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.

Estimado Amigo: Ya habia visto el articulo. El Dr. Quinn es conocido personal y muy serio investigador. En esencia plantea interesantemente algunas cosas ya conocidas dentro de un marco controlado de estudio. Entre otras cosas que la carga viral es un predictor independiente de transmision y que mientras mayor la carga viral mayor el riesgo.Otro punto que presenta es la poca diferencia si alguna, entre la taza de riesgo de transmision entre hombre-mujer, mujer-hombre.Esto no me sorprende ya que demuestra la poblacion cautiva dentro del nucleo relacion familiar y donde uno de los dos es ya positivo para VIH. Un punto que para mi es mas importante es el hecho de ausencia de seroconversion entre los varones circundados vs. los no circundados. Esto tiene para mi una importancia mayor de salud publica ya que en algunas culturas por tradicion ,al varon no se le hace circumsicion y esto pudiese repercutir en un mayor riesgo para infeccion.

Me complace que este buscando informacion relevante y de buena fuente. Lo felicito.

P.S. Por favor, la proxima vez con solo copiarme una vez la misiva es suficiente. Gracias y saludos