Brief report: HIV-1 transmissions during asymptomatic infection: exploring the impact of changes in HIV-1 viral load due to coinfections

J Acquir Immune Defic Syndr. 2015 Apr 15;68(5):594-8. doi: 10.1097/QAI.0000000000000511.

Abstract

High HIV-1 plasma viral loads (PVLs) in sub-Saharan Africa, partly because of high rates of coinfection, may have been one of the drivers of the "explosive" epidemics seen in that region. Using a previously published framework of infectiousness and survival, we estimate the excess onward HIV-1 transmission events (secondary infections) resulting from coinfection-induced changes in PVL during asymptomatic HIV-1 infection. For every 100 HIV-infected people, each suffering 1 episode of tuberculosis infection, there are 4.9 (2.7th-97.5th percentile: 0.2-21.5) excess onward HIV-1 transmission events attributable to this coinfection. Other estimates are malaria 0.4 (0.0-2.0), soil-transmitted helminths 3.1 (0.1-14.9), schistosomiasis 8.5 (0.2-38.6), filariasis 13.3 (0.3-89.2), syphilis 0.1 (0.0-1.6), herpes simplex virus 4.0 (0.0-24.2), and gonorrhea 2.1 (0.1-8.0) transmissions. If these higher PVLs confer a shorter life expectancy and higher infectiousness, then their impact on transmission is, in general, reduced. For most HIV-1 coinfections, the duration of a single infection is too short and/or the associated PVL elevation is too modest to contribute substantially to onward HIV-1 transmission.

MeSH terms

  • Adult
  • Africa South of the Sahara
  • Asymptomatic Infections
  • Bacterial Infections / epidemiology
  • Bacterial Infections / transmission*
  • Coinfection / epidemiology*
  • Female
  • HIV Infections / complications*
  • HIV Infections / transmission*
  • HIV-1 / isolation & purification*
  • Humans
  • Male
  • Parasitic Diseases / epidemiology
  • Parasitic Diseases / transmission*
  • Viral Load*