Pl. Vernazza et al., Biological correlates of sexual transmission of HIV: practical consequences and potential targets for public health, REV MED MIC, 12(3), 2001, pp. 131-142
The probability of sexual transmission of HIV depends on the infectiousness
of the index case and the susceptibility of the sexual contact. The risk o
f HIV transmission is heterogeneous and may be greatest during the initial
sexual contacts in a steady partnership. Several factors, including systemi
c and mucosal acquired protective immune response, might be responsible for
the apparent decrease of per-sex-act risk of transmission in a given partn
ership over time. Biological studies can be used to understand better the c
omplex information obtained from epidemiological surveys. The infectiousnes
s of HIV depends both on the inoculum and on virologic factors. The genital
tract viral load of the index case is probably the most important determin
ant of transmission. At the population level, interventions that reduce the
genital shedding of HIV by reducing systemic blood viral load and/or local
inflammatory processes are likely to have a beneficial impact on HIV incid
ence. Antiretroviral drugs are likely to reduce sexual transmission of HIV;
however, these drugs may not do so equally. Compartmentalised HIV replicat
ion in the male and female genital tract has been observed. Treatment with
antiretroviral drugs that penetrate the genital tract poorly pose the risk
of local production and spread of resistant viruses. In addition, increased
risk-taking behaviour could offset the benefits of reduced probability of
transmission at the population level. Biological data about HIV transmissio
n must be used to inform public health policies and optimise HIV prevention
strategies. (C) 2001 Lippincott Williams & Wilkins.