HTLV-3 infection and AIDS: risk of spread by heterosexual contact

This article reviews current research evidence on the natural history, epidemiology, and clinical features of acquired immunodeficiency disease (AIDS) and presents guidelines for controlling the sexual transmission of human lymphotropic virus type III (HTLV-III) infection. The rapid spread of HTLV-III infection through homosexual communities in the US and Europe and its association with promiscuity initially obscured the fact that heterosexual transmission is also a significant risk factor for infection. Public health workers and epidemiologists are examining which sexual practices are most associated with the transmission of HTLV-III infection. Case-control studies in homosexuals have suggested that promiscuity, passive anal intercourse, and other sexual practices associated with rectal trauma and bleeding correlate with infection. Similar studies involving heterosexuals have not been conducted. However, the following guidelines have been proposed for couples where 1 partner has been found to be positive for HTLV-III antibodies: 1) sexual partners should be confined to established relationships; 2) anal intercourse should be avoided, even if the male uses a condom; 3) no oral contact with semen should occur; 4) if vaginal intercourse is practiced, the use of condom is essential; and 5) the only practices that are free from risk of infection are mutual masturbation and hand caresses. Since a high proportion of children of women with HTLV-III develop severe immunodeficiency, it is undesirable for women who are HTLV-III antibody positive to become pregnant. Furthermore, there is evidence that women who are HTLV-III antibody positive are more likely to develop AIDS if they become pregnant. A reliable method of permanent or reversible contraception is recommended for these women. Finally, men who are antibody positive should not donate sperm to a sperm bank.     

Knowledge of partner risk and secondary transmission of HIV

BACKGROUND: The number and proportion of people living longer with HIV and the proportion of people infected heterosexually have increased. We measured the frequency with which people with heterosexually acquired AIDS knew their partners' risk behaviors, the extent of secondary heterosexual transmission of HIV, and characterized people at risk for secondary heterosexual transmission. METHODS: For each of five sites (Alabama, California, Florida, New Jersey, and Texas) and for New York City, a sample of adults with AIDS was interviewed. Primary heterosexual transmission was contact with a partner who had a known risk factor for HIV infection. Secondary transmission was contact with an HIV-positive partner not known to have a risk for HIV. RESULTS: Among men, 35% knew that a sexual partner was HIV infected, 56% of women knew that a sexual partner was HIV infected. Among women, 12% knew that a partner was bisexual. Overall, 79% (460 of 581) reported a partner with a primary risk for HIV; among men, 236 of 293 (81%), and among women, 224 of 288 (78%) reported a partner with a primary risk. People categorized with secondary transmission were significantly more likely to be black and never married. People categorized with secondary transmission were more frequently women (53%), had less than a high school education (48%), and a history of drug use (52%). Men categorized with secondary transmission of HIV had a mean of 22 heterosexual partners; women had a mean of 16 partners. CONCLUSIONS: We found that many heterosexuals with AIDS did not know their sexual partners' risk for HIV, and that secondary heterosexual transmission probably results in a small proportion of all AIDS cases in the U.S.     

福建省艾滋病感染的流行病学和病毒亚型 之间相互关系的研究

目的通过分子流行病学调查,明确福建省人类免疫缺陷病毒-1(HIV-1)流行毒株亚型与艾滋病(AIDS)流行的关系.方法通过艾滋病监测网络发现全省HIV/AIDS病例,应用核苷酸序列分析技术确定HIV-1亚型,结合流行病学资料分析福建省AIDS的流行状况.结果截至2000年底,全省累计发现188例HIV感染者,其中AIDS59例(已死亡53例).经异性性接触感染占65.4%,经血途径感染占9.0%,境外感染占44.1%,其中在东南亚等国家感染约占83.1%,境内感染占39.9%.41例HIV/AIDS病例的HIV-1亚型分析表明福建省存在A、B、C和E4种亚型,E亚型占75.6%(31/41),均为经异性性接触途径感染;B亚型17.1%(7/41),主要经血途径感染.A和C亚型分别为1和2例.E亚型基因离散率为(12.245±3.894)%,B亚型基因离散率为(10.762±2.707)%.表明福建省E亚型流行株的来源复杂,与感染地点、时间有关.结论福建省AIDS流行速度正在加快,病毒感染者主要经异性性接触途径感染,HIV-1流行毒株主要为E亚型.     

It takes two to tango but one to infect (on the underestimation of the calculated risk for infection with HIV in sexual encounters, arising from nondisclosure of previous risk behavior or seropositivity).

The effects of nondisclosure of either HIV seropositivity or previous engagement in risk behavior on the estimation of risk in sexual intercourse is studied through the use of a probability model. Equations are utilized to derive an Underestimation Factor for three cases, which is shown to range from 2 to 20 in the case of insertive anal intercourse between an HIV+ and an HIV- man, and to 1 x 10(4) in a similar case of heterosexual insertive vaginal intercourse. This factor remains constant regardless of the number of sexual encounters between the same partners, and regardless of the protective measures as long as unawareness prevails. The discussion focuses on the implications of this formulation for education and social attitudes toward disclosure and nondisclosure in sexual encounters. It also raises the question of moral responsibility of sexual partners and some legal aspects of nondisclosure.     

两种艾滋病病毒新近感染检测方法在比较不同感染途径患者死亡情况中的应用

目的应用两种艾滋病病毒(HIV)新近感染检测方法区分出HIV新近感染人群,探讨不同感染途径新近感染人群的死亡速度。方法采用ML-PA、BED-CEIA两种HIV-1新近感染检测方法对2006-2011年新报告的HIV/AIDS进行检测,对不同感染途径HIV/AIDS新近感染人群中位生存时间进行分析。结果对2006-2011年2 018例新报告的HIV/AIDS采用ML-PA进行HIV-1新近感染检测,得出新近感染64例(3.17%,95%CI:2.41%～5.58%),其中累计死亡3例(4.69%,95%CI:4.17%～5.29%),性、吸毒感染死亡分别2例、1例;对2009-2011年388例新报告的HIV/AIDS采用BED-CEIA进行HIV-1新近感染检测,得出新近感染35例(9.02%,95%CI:6.17%～15.19%),其中累计死亡2例(5.71%,95%CI:4.94%～6.48%),2例均为异性途径感染死亡。结论两种实验室HIV新近感染检测方法区分出的不同感染途径HIV/AIDS新近感染人群中位生存时间均大于2年。     

AIDS and heterosexual anal intercourse

Heterosexual anal intercourse is rarely discussed in the scientific literature. Review of the literature suggests the silence is linked to ethnocentric discomfort about it among researchers and health care providers, coupled with the misconception that anal sex is a homosexual male practice, not heterosexual. Review of surveys of sexual practices suggest that heterosexual anal intercourse is far more common than generally realized, more than 10% of American women and their male consorts engaging in the act with some regularity. Sexually transmitted disease (STD) data, especially where only the rectum is infected with gonorrhea or other STD agents, buttresses survey data. Considerably more heterosexuals engage in the act than do homosexual and bisexual men, not all of whom participate in anal coitus. Anal intercourse carries an AIDS risk for women greater than that for vaginal coitus, just as receptive anal intercourse carries a very high risk for males. Infection with the AIDS virus is increasingly documented in women engaging in anal coitus with infected males, in America, Europe, and Latin America. Women in Western countries are less likely to continue HIV infectivity chains than are males engaging in same-gender anal intercourse.     

影响艾滋病病毒异性性传播有关因素的研究

目的　了解中国中部地区艾滋病病毒 (HIV)异性性传播的特点及其影响因素。方法(1)现况研究 :在中国河南、河北等省农村寻找至少一方HIV阳性、有稳定婚姻、年龄 2 0～ 50岁的夫妻 ,由专业研究人员对其进行访谈 ,并采集夫妻双方抗凝全血样本 2 0ml,检测病毒载量、CD4 CD8细胞计数 ;(2 )病例对照研究 :以一方HIV阳性 ,通过性生活导致对方HIV感染的夫妻为病例 ,以一方HIV阳性、双方有正常的性生活 ,但对方未感染HIV的夫妻为对照 ,进行病例对照研究。结果　 (1)共收集到 87对至少一方HIV阳性的夫妻 ,其中病例夫妻 7对 ,对照夫妻 56对 ,发生HIV性传播的夫妻占全部有性传播危险夫妻的 11.1% ;(2 )在对照夫妻中 ,男方HIV阳性的 14对 ,占 2 5.0 % ,女方HIV阳性的 42对 ,占 75.0 % ;(3 )病例组性生活次数≥ 4次 月的比例显著高于对照组 (Fisher’s检验 ,P =0 .0 47,OR =8.0 )。病例组病毒载量≥ 10 5 拷贝 ml的比例显著高于对照组 (Fisher’s检验 ,P =0 .0 16,OR =2 2 .0 )。病例组先感染一方的HIV病毒载量显著高于对照组的感染一方 (t=3 .591,P <0 .0 1)、而CD4细胞计数和CD4 CD8比值均显著低于对照组的感染一方 (t=2 .767,P <0 .0 5;t =6.0 6,P <0 .0 5)。结论　中国中部地区有稳定婚姻的夫妻中HIV异性性传播的     

Infected sex partner wins dismissal of assault charges

The California Court of Appeals ruled that a man who had unprotected intercourse with an underage female without disclosing his positive HIV status cannot be charged with aggravated assault. The court determined that prosecutors did not prove that the risk of HIV transmission from one act of unprotected heterosexual sex fell within California's definition of aggravated assault. The defendant, Dennis Guevara, will face trial on four counts of unlawful sexual intercourse, one count of failing to register as a sex offender, and two counts of assault with a deadly weapon. Guevara argued that because the sex was consensual he could not be convicted of aggravated assault; this argument was rejected. Guevara also argued that California's statutes violate his equal protection rights under the Constitution because they apply only to adult men who have sex with women and not the reverse. He also argued that the statutes discriminate against HIV carriers. The Supreme Court stated that the gender distinction protects women from becoming infected and passing the infection on to her infant in utero.     

Epidemiological and clinical features of HIV-2 infection in Dakar

OBJECTIVE: The aim of this article was to describe the epidemiological and clinical aspects of HIV-2 infection in Dakar. DESIGN AND METHODS: This retrospective study was made on 217 HIV-2 infected patients hospitalized between 1986 and 2003; the epidemiological, clinical, and paraclinical data was collected and analyzed using the Epi-Info software version 6.04. RESULTS: The mean age was 40 years+/-9.6 and the male to female sex ratio was 1.33. The mode of transmission was primarily heterosexual. Some risk factors (travel abroad, heterosexual multi-partners, and unprotected sexual intercourse) were more frequently observed in men while others (blood transfusion, HIV positive partners) were noted among HIV-2 infected women. The most frequent symptoms were weight loss (88%), diarrhea (77%), fever (72.4%), asthenia (70.5%), chronic cough, and dermatosis (50.7%). The main opportunistic infections were oral candidiasis (61.8%), tuberculosis (26.3%), intestinal parasitosis (20.3%). The lethality rate was 33.2% and it was correlated with a low CD4 rate. Meningoencephalitis and bacterial infections were associated with a high lethality rate. CONCLUSIONS: The epidemiological and clinical aspects of HIV-2 infection were the same as in HIV-1 infected patients. However the lethality rate remained high among patients hospitalized with a low CD4 cell count. Early HIV testing and improving the diagnostic approach for opportunistic infections remains a high priority.     

云南省2015年新报告988例非婚异性传播HIV/AIDS病例性行为及影响因素分析

目的 了解人类免疫缺陷病毒（human immunodeficiency virus,HIV）感染者/获得性免疫缺陷综合征（acquired immunodeficiency syndrome,AIDS）患者经非婚异性性接触感染的高危性行为特点及其影响因素,为控制艾滋病经性传播策略制定提供科学数据。方法 连续抽取云南省2015年新报告非婚异性传播HIV/AIDS病例,进行问卷调查,了解调查对象获知感染HIV前后危险行为等情况。结果 调查男性498人、女性490人。获知感染HIV前一年内有商业性行为的比例为39.88%（男性占68.67%,女性占10.61%）,性别差异有统计学意义（χ2=352.797,P<0.001）,地点集中在路边店/街头,坚持使用安全套比例仅为8.38%;71.36%有临时性伴间性行为（男性占64.46%,女性占78.37%）,且性别差异有统计学意义（χ2=23.379,P<0.001）,临时性伴主要是朋友/熟人（占82.52%）;存在多种性行为交叉和叠加。获知感染HIV后仍有12.96%发生高危性行为,仅31.86%愿意告知性伴自身的感染状况。结论 异性传播影响人群扩大,控制异性传播的策略应转为在强化高危人群干预工作基础上,倡导全民推广使用安全套的普遍防护,宣传教育时增加风险行为识别和安全性行为警示性教育,艾滋病感染者随访管理工作中应评估其传播风险并采取相应措施。     

男男性行为人群同性恋身份自我认同与艾滋病危险因素的相关性

[目的]探索男男性接触者（MSM）对自己同性恋身份的认同及其与艾滋病相关危险因素的关系。[方法]使用统一设计的调查问卷,对利用＂滚雪球＂、＂网络动员＂等途径招募的151名MSM采用匿名面对面询问方式调查其自我认同、性行为、性伴网络、吸毒史和健康相关行为。[结果]消极自我认同的比例为56.29%（85/151）。文化程度与自我认同有关联性（χ2=8.022,P〈0.05）。自认性取向为同性恋的积极自我认同比例高于自认性取向为双性恋和异性恋者（χ2=5.108,P〈0.05）。不同自我认同和与男性首次性行为年龄、与异性结婚可能性、人类免疫缺陷病毒（HIV）抗体检测率、过去6个月有异性性伴/固定男性伴/多次男性伴等因素的关联有统计学意义（P值均〈0.05）,其中积极自我认同的MSM与男性首次性行为更多发生在20岁以前、与异性结婚可能性小、更易接受HIV检测服务、拥有固定男性伴比例高、拥有异性性伴和多次男性伴的比例小。[结论]MSM人群消极自我认同的比例较高,其无保护性交和多性伴较广泛地存在,主动求医进行HIV抗体检测率较低,感染HIV危险性和传播桥梁作用也更大。应广泛开展社会反歧视宣传,促进MSM积极自我认同,增进艾滋病预防服务利用,有效降低艾滋病传播的风险。     

重庆市部分地区新报告异性性传播HIV/AIDS感染方式分析

目的 了解重庆市部分地区新报告异性性传播HIV/AIDS的感染方式,为有效开展艾滋病经异性性传播的防控提供依据。方法 对重庆市部分地区2019年7月1日至10月1日新报告的异性性传播HIV/AIDS展开面对面问卷调查,收集社会人口学特征、异性性行为情况等相关数据。结果 共完成312例异性性传播HIV/AIDS的问卷调查,主要以男性（207,66.3%）、≥50岁（210,67.3%）、初中及以下文化程度（252,80.8%）、已婚或同居者（200,64.1%）为主。经商业性行为感染占48.7%（152/312）,经配偶/固定性伴感染占40.4%（126/312）,经非商业临时性行为感染占10.9%（34/312）。不同性别、年龄、职业的HIV/AIDS,感染方式差异有统计学意义（P<0.05）。多因素logistic回归分析结果显示,相比于经配偶/固定性伴感染,男性（OR=822.34,95% CI：103.99～6 503.10）、初中及以下文化程度者（OR=3.02,95% CI：1.05～8.66）的商业性行为感染HIV风险更大;而家务/待业者（OR=0.23,95% CI：0.07～0.76）的商业性行为感染HIV的风险更小;男性（OR=29.20,95% CI：9.40～90.75）、初中及以下文化程度者（OR=4.28,95% CI：1.24～14.81）的非商业临时性行为感染HIV的风险更大。除了在线下场所结识非婚异性性伴,有一定比例（6.2%）HIV/AIDS通过线上交友发展性伴关系,且性伴交往场所以低档为主。结论 重庆市部分地区新报告异性性传播HIV/AIDS的感染方式以线下低档场所结识性伴,并经商业性行为感染为主,应深入了解异性性传播HIV/AIDS的感染方式,制定有针对性的干预策略。     

Cross-sectional study of sexual behaviour and knowledge about HIV among urban, rural, and minority residents in Viet Nam

OBJECTIVE: A cross-sectional survey was conducted in three districts of Quang Ninh province, Viet Nam, to find out what proportion of the people who lived there engaged in behaviour that put them at risk of becoming infected with HIV, and to measure their knowledge about HIV infection and AIDS. METHODS: The survey was conducted in a rural district, Yen Hung; a mountainous district inhabited primarily by ethnic minority groups, Binh Lieu; and an urban district, Ha Long. Participants aged 15-45 years were randomly selected from the general population to be interviewed. FINDINGS: A total of 630 people from 707 households were interviewed; 8% were not home despite repeated visits and 3% refused to participate. The prevalence of premarital intercourse ranged from 9% to 16% among married men and 4% to 7% among married women. Among single men the proportion who had ever had intercourse ranged from 6% to 16%. Fewer than 3% reported having ever had sex with a sex worker. The median number of extramarital sex partners was 1. Knowledge about HIV/AIDS was high in the urban and rural areas but low in the mountainous area. Being male and being 20-29 years old were associated with having multiple sex partners. CONCLUSION: The low prevalence of individuals reporting that they had had intercourse with sex workers and partners other than their spouse may explain the low rates of HIV infection among the heterosexual population; these rates are in contrast to the high rates of HIV infection found among injecting drug users. The association between having extramarital partners and being a younger man suggests that the tendency to have more sexual partners may increase in the future. If this happens, the potential for HIV to be spread through heterosexual sex will increase.     

六安市艾滋病异性传播病例感染方式特征分析

目的 了解六安市艾滋病异性传播主要感染方式及不同感染方式的人群特征。方法 以国家艾滋病综合防治信息系统中现住址为六安市、传播途径为异性传播的HIV/AIDS病例为调查对象,采用自行设计的调查问卷收集调查对象的社会人口学特征及异性传播方式。结果 共调查符合纳入标准HIV/AIDS 340例,其中经商业性性行为传播占59.4%（202/340）,经配偶或固定性伴传播占18.8%（64/340）,非商业性临时性伴占21.8%（74/340）。性别、年龄、文化程度及婚姻状况是异性传播方式的影响因素。经商业性性行为传播比例始终维持在较高水平,非商业性临时性伴传播比例近几年上升趋势明显,配偶或固定性伴传播比例呈下降趋势,在3个传播方式中水平最低。结论 六安市艾滋病异性传播以经商业性性行为感染方式为主,但不同人群异性传播方式差异较大,需要采取有针对性的干预措施。     

The potential for spread of HIV in the heterosexual population in Norway: a model study

A simulation model is used to investigate the potential for indigenous spread of human immunodeficiency virus (HIV) in the heterosexual population in Norway. The heterosexual population is grouped according to age, sex and whether paired or single. Estimates of various parameters of sexual behaviour are taken from a population-based questionnaire study. The questionnaire was sent to a random sample of 10,000 individuals, with a response rate of 63 per cent. The main simulation result is that with no inflow of infection from other risk groups, the heterosexual epidemic will decline if the average transmission probability per intercourse is 1 per cent or less. This result is insensitive to changes in the initial conditions. It is sensitive to changes in sexual behaviour, and to the shape of the transmission probability distribution. A review of empirical partner study data indicates an average transmission probability about 0.1 per cent per intercourse when no transmission modulating cofactors are present. It is concluded that with present sexual behaviour, the indigenous spread of HIV is not likely to sustain an epidemic in the Norwegian heterosexual population.     

东宁口岸2002—2007年入境人员艾滋病、梅毒监测结果分析

目的监测俄罗斯符拉迪沃斯托克对应的一级陆路口岸东宁口岸入境人员艾滋病、梅毒感染情况。方法对东宁口岸5年期间在国外居住三个月以上的入境人员在口岸现场实施艾滋病、梅毒快速检测与流行病学调查。结果该口岸、对应口岸梅毒、艾滋病患者主要传播途径主要是性传播；梅毒、艾滋病患者传染源流行病学调查结果均为异性性伙伴。结论黑龙江口岸归国人员梅毒、艾滋病传播风险在逐年增加。     

Aids caused by HIV-2 in The Netherlands

In four patients in Rotterdam AIDS was diagnosed, and it was subsequently demonstrated that they were infected with HIV type 2. One of the patients was an immigrant from the Cape Verde islands, two of the others had heterosexual contacts with persons of this area, and the fourth patient was a male homosexual without known contacts with Africans. The Cape Verde islands are one of the areas in which HIV-2 infection occurs, and because of immigration into The Netherlands and in particular to Rotterdam, the possibility of HIV-2 infection should be considered in persons of this population group and their sexual contacts. Furthermore, problems with serologic investigations should be avoided by the application of HIV-2 specific confirmatory assays.     

Opportunistic Intestinal Parasite Infection and Mode of Sexual Intercourse of HIV-Infected Patients in the Era of HAART

One of the major health problems among HIV-infected patients is the intestinal parasite infestations. At present, opportunistic intestinal parasite infection is very common in patients with HIV/AIDS and remains a treat to public health. Association of HIV infection with gut parasites is likely to be related to sexual modes of contact that favour both HIV and the parasite. A cross-sectional study to determine the correlation between opportunistic intestinal parasite infection and mode of sexual intercourse among HIV/AIDS patients was conducted. In the study of 40 HIV/AIDS adult patients with diarrhea, a total of 38 cases with heterosexual mode of intercourse and 2 with homosexual mode of intercourse were reported during the study period. Of interest, there is no association between opportunistic intestinal parasite infection and mode of sexual intercourse of HIV-infected patients (P value > 0.05).     

Infectiousness of HIV between male homosexual partners

To estimate the risk of transmission of HIV per receptive anal sexual contact, 329 homosexually-active men, representing 155 sexual partnerships, were enrolled into a study. Information on HIV infection status and sexual behavior within and outside the primary relationship was collected. Of these 329 men, 24 had AIDS and 31 had ARC. Of the 155 couples, 35 consisted of partners that were both HIV +; 62 of partners that were both HIV-; and 58 were discordant. A binomial model was fit to data obtained in the first visit to estimate per contact risk of HIV transmission. Assuming a constant risk of transmission per sexual contact between infected and uninfected partners, the estimated risk is about 5 to 30 per 1000 receptive anal exposures to ejaculate. Although the average risk of HIV transmission per sexual contact appears to be low, there appears to be great variability in infectivity. To model this variability over time and across individuals, more complex models must be fit to longitudinal studies of sexual partners.     

坚持使用避孕套情况下的夫妻间艾滋病病毒感染因素分析

目的　避孕套干预对夫妻间艾滋病病毒（ＨＩＶ） 传播的作用。方法　为首例ＨＩＶ感染者建立个人档案,固定流行病学医师对感染者和配偶每６ 个月进行一次ＨＩＶ抗体检测和家庭随访,ＨＩＶ抗体检测采用ＥＬＩＳＡ、ＰＡ、ＷＢ法,阳性结果由山东省卫生防疫站确认。结果　首例男性１９９２ 年入境时确认ＨＩＶ感染。卫生防疫人员立即对感染者夫妇进行了预防ＡＩＤＳ教育。几年来配偶间性接触均使用避孕套,但使用前未进行破损检查。其配偶１９９７ 年５ 月曾出现不明原因低热１月余,同年８ 月在第１４ 次检测时阳性,并确认为ＨＩＶ－ １ 型感染。结论　使用避孕套可在较长时间内预防ＨＩＶ经性接触感染,但不正确使用仍可造成ＨＩＶ感染。