American Journal of Epidemiology Vol. 137, No. 8: 899-908
Copyright © 1993 by The Johns Hopkins University School of Hygiene and Public Health
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Risk of Human Immunodeficiency Virus Infection from Unprotected Receptive Anal Intercourse Increases with Decline in Immunologic Status of Infected Partners
1Institute for Urban Health Policy and Research, Boston Department of Health and Hospitals Boston, MA
2Department of Epidemiology and Biostatistics, Boston University School of Public Health Boston, MA
3Fenway Community Health Center Boston, MA
4Memorial Hospital Pawtucket RI
5Brown University Medical School Providence, RI
6Epidemiology Branch, Division of HIV/AIDS Center for Infectious Diseases, Centers for Disease Control Atlanta, GA
Reprint requests to Dr. George R. Seage III, Institute for Urban Health Policy and Research, Boston Department of Health and Hospitals, 1010 Massachusetts Ave., Boston, MA 02118.
To determine whether human immunodeficiency virus (HIV) type 1 infection among unprotected receptive anal partners of HIV type 1-infected men varies by the immunologic status of the HIV type 1-infected index case, 187 sexual partners of 164 HIV type 1-infected index subjects were enrolled at a community health center in Boston, Massachusetts, from 1985–1990. All subjects were interviewed regarding their sexual practices and tested for HIV type 1. Fifty-seven of the 187 sexual partners were infected with HIV type 1. The strongest risk factor for HIV type 1 infection among these partners was unprotected receptive anal intercourse with a known HIV type 1-infected index subject (odds ratio (OR)= 7.2, 95% confidence interval (Cl) 3.1–16.3). The risk of unprotected receptive anal intercourse was highest among partners of HIV-infected index subjects who had a T lymphocyte subset ratio of 0.50 or less (OR =11.4, 95% Cl 3.0–43.5) compared with partners of HIV type 1-infected index subjects with a T cell ratio of greater than 0.50 (OR = 5.3, 95% Cl 1.9–15.2). After adjustment for confounding, the risk of HIV type 1 infection remained substantially higher among sexual partners who had had unprotected receptive anal intercourse with infected index subjects with a T lymphocyte subset ratio of less than or equal to 0.50 (OR = 7.0, 95% Cl 1.8–28.0) compared with partners who had had unprotected receptive anal intercourse with infected index subjects with a T cell ratio of greater than 0.50 (OR = 3.3, 95% Cl 1.1–10.0). It would appear that the risk of HIV type 1 infection from unprotected receptive anal intercourse increases as the immunologic status of the HIV type 1-infected insertive anal partner decreases.
antigens; CD4; antigens; CD8; CD4-CD8 ratio; HIV infections; homosexuality; T-lymphocyte subsets; sexual partners; sexually transmitted diseases
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