Summary
The incidence of male-to-female transmission of HIV infection was studied in a population of 198 sexual partners of hemophiliacs who tested HIV positive since 1984. The follow-up observation period was 1987–1992. Transmission occurred in 20 (10%) cases. The analysis of risk factors for transmission was performed in a subgroup of 57 hemophiliacs with seronegative sexual partners as compared to eight transmitters. Transmitters showed a significantly more advanced immune depletion at enrollment as well as at the end of the observation period. Furthermore, transmitters had a more advanced disease at the end of the study (75% vs. 29% CDC IV; p<0.01). Also virus cultures were more frequently positive in the transmitters than in the non-transmitters (71% vs. 42%). Regular sexual counseling was offered to all couples. After 1987, no new seroconversions were detected. However, two seroconversions in female partners of hemophiliacs outside the initial study population were observed. Both transmissions occurred during a period of severe clinical and immunological deterioration. This study shows that sexual partners of HIV-infected hemophiliacs with more advanced disease are at higher risk of infection with HIV. The frequency of male-to-female transmission of HIV in long-term monogamous sexual relationships practicing safer sex is low. Overall, disease awareness and counseling for safer sex seem to be effective in reducing transmission rates.
Zusammenfassung
Die Inzidenz der Übertragung der HIV-Infektion von Männern auf Frauen wurde in einer Population von 198 weiblichen Sexualpartnern von seit 1984 HIV-positiv getesteten Hämophilen untersucht. Die Nachbeobachtungsdauer erstreckte sich über die Jahre 1987–1992. Die Infektion wurde in 20 Fällen (10%) übertragen. Die Analyse von Risikofaktoren für die Übertragung von HIV wurde untersucht durch den Vergleich einer Untergruppe von 57 Hämophilen und seronegativen Partnern mit 8 Überträgern. Die Überträger zeigten zu Beginn als auch am Ende der Beobachtungszeit eine fortgeschrittenere Immundepletion. Darüber hinaus wiesen Überträger am Ende der Studie auch häufiger eine symptomatische Erkrankung auf (75% versus 29% CDC IV; p<0,01). Darüber hinaus war bei Überträgern 1991/92 häufiger eine positive Viruskultur nachweisbar (71% vs. 42%). Allen Paaren wurde eine regelmäßige Sexualberatung angeboten. Nach 1987 wurden keine neuen Serokonversionen beobachtet. Jedoch wurden zwei Serokonversionen bei Partnerinnen hämophiler HIV-infizierter außerhalb der ursprünglichen Population aufgedeckt. Beide Übertragungen erfolgten in einer Periode schweren klinischen und immunologischen Progresses. Unsere Studie zeigt, daß Sexualpartner von Hämophilen mit fortgeschrittener HIV-Infektion ein höheres Übertragungsrisiko aufweisen. Die Übertragungsfähigkeit von Männern auf Frauen ist auch bei langdauernden Sexualbeziehungen monogamer Paare, die safer sex praktizieren, gering. Das Wissen um das Vorliegen einer HIV-Infektion und Beratung über safer sex scheinen wirksam in der Verhütung von Neuinfektionen.
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Rockstroh, J.K., Ewig, S., Bauer, T. et al. Male-to-female transmission of HIV in a cohort of hemophiliacs — Frequency, risk factors and effect of sexual counseling. Infection 23, 29–32 (1995). https://doi.org/10.1007/BF01710054
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DOI: https://doi.org/10.1007/BF01710054