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  • Title: [Heterosexual transmission of HIV infection]].
    Author: Coulaud JP.
    Journal: Contracept Fertil Sex (Paris); 1993 Feb; 21(2):145-8. PubMed ID: 12318013.
    Abstract:
    The AIDS epidemic has spread rapidly in Africa among the urban impoverished where multiple sexual partners and sexually transmitted diseases are common. Over 80% of the 9 million Africans who will develop AIDS before the year 2000 will have been contaminated sexually. Poverty, multiple sexual partners in the framework of prostitution, and drug addiction are responsible for rapid spread of HIV infection in Southeast Asia, the West India, and Brazil. Drug addiction has played a major role in diffusion of HIV into the general population of Europe and the US. Prevalence rates are much higher in sexually transmitted disease centers in France and the US than among blood donors or pregnant women. Sexually transmitted diseases and heterosexual transmission have been studied in Africas since diagnostic tests became available. Several studies, the majority conducted among prostitutes in Nairobi or Kinshasa and their clients, allow establishment of a list of sexually transmitted diseases associated with increased risk of seroconversion. Genital ulcers within the past 6 months presented a relative risk of 2-4 depending on the series. Urethral or cervical gonorrhea has a lower relative risk of 1.2 in most studies. Absence of circumcision was also a risk factor. Studies were subsequently conducted in Europe on factors favoring sexual transmission. 513 heterosexual couples together for a minimum duration of 18 months and an average of 38 months were included in the Multicenter European Study conducted in 10 centers in 9 countries. The "index" subject was male in 400 cases and female in 113. At entry into the study, 73 of 400 males (18.2%) and 10 of 113 females (8.8%) had already infected their partners. Duration of union, frequency of intercourse, mode of transmission of the index subject, and oral contraceptive use had no effect on risk of transmission. Factors increasing risk of infection included the severity of immunosuppression of the index subject, whether judged by clinical classification of stage 4 vs. earlier stages, or by a level of CD4 lymphocytes of under 200 vs. over 200. The overall relative risk is 2.4 if there is a history of sexually transmitted disease in the past 5 years. Women are particularly vulnerable to the risk of sodomy, with a relative risk of 5.1 and an increase in there risk of transmission from 11.3 to 40%. Age over 45 is associated with an increase from 17 to 44% and a relative risk of 3.4 in women, probably because of greater fragility of the mucus in the postmenopausal period. For men, the relative risk of intercourse during menstruation is 9.6 and the rate increases from 3% to 20%. The greater risk of male to female transmission confirms impressions of earlier studies but should not be regarded as definitive. Condom use was shown to be effective in follow- up of discordant couples. 9 seroconversions occurred in an average follow-up of 12 months among 89 couples not using condoms, compared to 0 in 80 couples regularly using them.
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