Evidence map›Paper›PMID 30455270›Full record

SynthesisCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2018

Risk of sexual transmission of human immunodeficiency virus with antiretroviral therapy, suppressed viral load and condom use: a systematic review.

Jennifer LeMessurier, Gregory Traversy, Olivia Varsaneux, Makenzie Weekes, Marc T Avey, Oscar Niragira, Robert Gervais, Gordon Guyatt, Rachel Rodin

Open access · goldAbstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 59 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
59citing papers in PubMed, 1 pooled it
7.2field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

59 citing papers in PubMed, 1 synthesis or guideline pooled it, 113 citations in OpenAlex.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors at 1 institution in 1 country.

Jennifer LeMessurierCentre for Communicable Diseases and Infection Control (Traversy, Varsaneux, Weekes, Avey, Niragira, Gervais, Rodin), Public Health Agency of Canada; Department of Family Medicine (LeMessurier) and School of Epidemiology and Public Health (LeMessurier), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence, and Impact (Guyatt), McMaster University, Hamilton, Ont.
Gregory TraversyCentre for Communicable Diseases and Infection Control (Traversy, Varsaneux, Weekes, Avey, Niragira, Gervais, Rodin), Public Health Agency of Canada; Department of Family Medicine (LeMessurier) and School of Epidemiology and Public Health (LeMessurier), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence, and Impact (Guyatt), McMaster University, Hamilton, Ont.
Olivia VarsaneuxCentre for Communicable Diseases and Infection Control (Traversy, Varsaneux, Weekes, Avey, Niragira, Gervais, Rodin), Public Health Agency of Canada; Department of Family Medicine (LeMessurier) and School of Epidemiology and Public Health (LeMessurier), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence, and Impact (Guyatt), McMaster University, Hamilton, Ont.
Makenzie WeekesCentre for Communicable Diseases and Infection Control (Traversy, Varsaneux, Weekes, Avey, Niragira, Gervais, Rodin), Public Health Agency of Canada; Department of Family Medicine (LeMessurier) and School of Epidemiology and Public Health (LeMessurier), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence, and Impact (Guyatt), McMaster University, Hamilton, Ont.
Marc T AveyCentre for Communicable Diseases and Infection Control (Traversy, Varsaneux, Weekes, Avey, Niragira, Gervais, Rodin), Public Health Agency of Canada; Department of Family Medicine (LeMessurier) and School of Epidemiology and Public Health (LeMessurier), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence, and Impact (Guyatt), McMaster University, Hamilton, Ont.
Oscar NiragiraCentre for Communicable Diseases and Infection Control (Traversy, Varsaneux, Weekes, Avey, Niragira, Gervais, Rodin), Public Health Agency of Canada; Department of Family Medicine (LeMessurier) and School of Epidemiology and Public Health (LeMessurier), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence, and Impact (Guyatt), McMaster University, Hamilton, Ont.
Robert GervaisCentre for Communicable Diseases and Infection Control (Traversy, Varsaneux, Weekes, Avey, Niragira, Gervais, Rodin), Public Health Agency of Canada; Department of Family Medicine (LeMessurier) and School of Epidemiology and Public Health (LeMessurier), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence, and Impact (Guyatt), McMaster University, Hamilton, Ont.
Gordon GuyattCentre for Communicable Diseases and Infection Control (Traversy, Varsaneux, Weekes, Avey, Niragira, Gervais, Rodin), Public Health Agency of Canada; Department of Family Medicine (LeMessurier) and School of Epidemiology and Public Health (LeMessurier), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence, and Impact (Guyatt), McMaster University, Hamilton, Ont.
Rachel RodinCentre for Communicable Diseases and Infection Control (Traversy, Varsaneux, Weekes, Avey, Niragira, Gervais, Rodin), Public Health Agency of Canada; Department of Family Medicine (LeMessurier) and School of Epidemiology and Public Health (LeMessurier), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence, and Impact (Guyatt), McMaster University, Hamilton, Ont. rachel.rodin@canada.ca.
Public Health Agency of Canada · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe Public Health Agency of Canada reviewed sexual transmission of HIV between serodiscordant partners to support examination of the criminal justice system response to HIV nondisclosure by the Department of Justice of Canada. We sought to determine HIV transmission risk when an HIV-positive partner takes antiretroviral therapy, has a suppressed viral load or uses condoms.

methodsWe conducted an overview and systematic review update by searching MEDLINE and other databases (Jan. 1, 2007, to Mar. 13, 2017; and Nov. 1, 2012, to Apr. 27, 2017, respectively). We considered reviews and studies about absolute risk of sexual transmission of HIV between serodiscordant partners to be eligible for inclusion. We used A Measurement Tool to Assess Systematic Reviews (AMSTAR) for review quality, Quality in Prognosis Studies (QUIPS) instrument for study risk of bias and then the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to assess the quality of evidence across studies. We calculated HIV incidence per 100 person-years with 95% confidence intervals (CIs). We assigned risk categories according to potential for and evidence of HIV transmission.

resultsWe identified 12 reviews. We selected 1 review to estimate risk of HIV transmission for condom use without antiretroviral therapy (1.14 transmissions/100 person-years, 95% CI 0.56-2.04; low risk). We identified 11 studies with 23 transmissions over 10 511 person-years with antiretroviral therapy (0.22 transmissions/ 100 person-years, 95% CI 0.14-0.33; low risk). We found no transmissions with antiretroviral therapy and a viral load of less than 200 copies/mL across consecutive measurements 4 to 6 months apart (0.00 transmissions/100 person-years, 95% CI 0.00-0.28; negligible risk regardless of condom use).

interpretationBased on high-quality evidence, there is a negligible risk of sexual transmission of HIV when an HIV-positive sex partner adheres to antiretroviral therapy and maintains a suppressed viral load of less than 200 copies/mL measured every 4 to 6 months. Sexual transmissions of HIV have occurred when viral load was more than 200 copies/mL with antiretroviral therapy or condoms alone were used, although the risk remains low. These findings will help to support patient and clinician decision-making, affect public health case management and contact tracing, and inform justice system responses to HIV nondisclosure.

Indexed as

CondomsSafe SexViral LoadAnti-HIV AgentsHIV InfectionsHumansRiskSustained Virologic ResponseAnti-HIV Agents

Identifiers

PMID30455270
PMCPMC6239917
OpenAlexW2901312042

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.