SynthesisClinical infectious diseases : an official publication of the Infectious Diseases Society of America2014
Heterosexual risk of HIV transmission per sexual act under combined antiretroviral therapy: systematic review and bayesian modeling.
Synthesis in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
16 citing papers in PubMed, 2 syntheses or guidelines pooled it, 40 citations in OpenAlex.
- The Association Between Different Levels of Suppressed Viral Load and the Risk of Sexual Transmission of HIV Among Serodiscordant Couples on Antiretroviral Therapy: A Systematic Review.AIDS and behavior · 2026Pooled it
- Risk of sexual transmission of human immunodeficiency virus with antiretroviral therapy, suppressed viral load and condom use: a systematic review.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2018Pooled it
- Treatment as Prevention: Characterization of Partner Infections in the HIV Prevention Trials Network 052 Trial.Journal of acquired immune deficiency syndromes (1999) · 2017Trial
- Protease inhibitor monotherapy for long-term management of HIV infection: a randomised, controlled, open-label, non-inferiority trial.The lancet. HIV · 2015Trial
- Development and genomic characterization of a diverse HIV-1 variant reference panel for nucleic acid-based testing.Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology · 2026Article
- Sustaining Rwanda's HIV response after elimination of PEPFAR funding: a modelling analysis of HIV epidemic and care continuum outcomes.Journal of the International AIDS Society · 2026Article
- Article
- Drivers of HIV-1 drug resistance to non-nucleoside reverse-transcriptase inhibitors (NNRTIs) in nine southern African countries: a modelling study.BMC infectious diseases · 2021Article
- Successful Pregnancy and Delivery with Intracytoplasmic Sperm Injection in HIV-Serodiscordant Couple: the First Case in Korea.Journal of Korean medical science · 2020Article
- Expert consensus statement on the science of HIV in the context of criminal law.Journal of the International AIDS Society · 2018Article
- HIV prevention strategies and risk of infection: a model-based analysis.Epidemiology and infection · 2018Article
- Are HIV Seroconversions Among Young Men Who Have Sex With Men Associated With Social Network Proximity to Recently or Long-Term HIV-Infected Individuals?Journal of acquired immune deficiency syndromes (1999) · 2018Article
- HIV Transmission Risk Persists During the First 6 Months of Antiretroviral Therapy.Journal of acquired immune deficiency syndromes (1999) · 2016Article
- Reevaluating Cumulative HIV-1 Viral Load as a Prognostic Predictor: Predicting Opportunistic Infection Incidence and Mortality in a Ugandan Cohort.American journal of epidemiology · 2016Article
- Article
- Advances in HIV prevention for serodiscordant couples.Current HIV/AIDS reports · 2014Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAlthough essential for patient counseling and quality of life of human immunodeficiency virus (HIV)-infected individuals, the risk of HIV transmission during 1 unprotected sex act with an HIV-infected person under combination antiretroviral therapy (cART) remains unknown.
methodsWe reviewed systematically the literature for studies on HIV transmission among heterosexual HIV-serodiscordant couples, where the infected partner was on cART, with regular virological monitoring, reporting on condom use and sexual activity. We used Bayesian statistics to combine data from selected studies, to investigate the per-act risk of HIV transmission through unprotected sex with an HIV-infected person on cART for >6 months.
resultsAt most, 1 HIV transmission, over an estimated 113 480 sex acts, of which 17% were not condom protected, was reported within 1672 HIV-serodiscordant couples where the index partner had been treated for >6 months. Data were insufficient to determine whether the reported transmission occurred before or after 6 months of cART. We estimated the upper-bound per-act risk of HIV transmission at either 8.7 or 13:100 000, depending on whether the transmission occurred before or after 6 months of cART. These estimates applied whether or not index partners were virally suppressed. Estimating an upper-bound risk <1:100 000 would require observing no HIV transmission while collecting >12 times the available amount of data.
conclusionsAvailable data do not support zero risk of HIV transmission under cART. The per-act risk of HIV transmission through unprotected sex with HIV-infected individuals on cART in comprehensive care for >6 months (whether or not virally suppressed) is <13:100 000. Estimating a 10-fold lower upper-bound risk may be unfeasible due to high condom use among HIV-serodiscordant couples in most research studies.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.