RESUMEN
OBJECTIVE: To evaluate the effectiveness and safety of assisted reproduction techniques (ART) in human immunodeficiency virus (HIV) serodiscordant couples. DESIGN: Systematic review of five databases of noncomparative open intervention and observational studies of serodiscordant couples undergoing ART, with study selection and data extraction performed independently and in duplicate. SETTING: Tertiary fertility centers. PATIENT(S): HIV serodiscordant couples where the man is HIV positive. INTERVENTION(S): Intrauterine insemination (IUI), in vitro fertilization (IVF), or intracytoplasmic injection (ICSI) performed after washed semen viral testing. MAIN OUTCOME MEASURE(S): Pregnancy rates per cycle, cumulative pregnancy, abortion rate, and HIV seroconversion in newborns or women. RESULT(S): Of the 658 abstracts retrieved, 41 were selected for review, and 17 full articles were included (3,900 IUI cycles in 1,184 couples in 11 aggregated studies and 738 ICSI/IVF cycles in 579 couples across 10 studies). The IUI and ICSI results were, respectively: pregnancy rates per cycle, 18% and 38.1%; cumulative pregnancy, 50% and 52.9%; and abortion rate, 15.6% and 20.6%. No seroconversions in women or newborns were detectable at birth or after 3 to 6 months. CONCLUSION(S): Cumulative evidence suggests that ART is safe and effective for avoiding horizontal and vertical transmission in HIV serodiscordant couples.
Asunto(s)
Infecciones por VIH/prevención & control , VIH-1 , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Técnicas Reproductivas Asistidas , Semen/virología , Composición Familiar , Femenino , Infecciones por VIH/transmisión , Seropositividad para VIH/epidemiología , Seropositividad para VIH/patología , Seropositividad para VIH/transmisión , Seropositividad para VIH/virología , VIH-1/fisiología , Humanos , Masculino , Embarazo , Técnicas Reproductivas Asistidas/efectos adversos , Semen/fisiología , Resultado del TratamientoRESUMEN
To evaluate the relation between illicit drug use, sexual practices, and socioeconomic status, we analyzed data from the baseline interview of a cohort of 675 men who have sex with men conducted from 1994 to 1999 in Rio de Janeiro, Brazil. Bivariate analyses of factors associated with crack/cocaine use with sex revealed that men who reported crack/cocaine use were significantly ( p <.05) more likely than men who did not report drug use to be unemployed (42.7% vs. 29.1%), to have an income of <$250 per month (70.7% vs. 60.9%), to have <8 years of education (69.5% vs. 50.9%), to report bisexual activity (81.7% vs. 41.7%), and to engage in commercial sex (72.0% vs. 37.9%). Multivariate analysis of factors associated with unprotected anal sex with casual male partners in the last 6 months demonstrated that the following variables were associated with this outcome: an income <$250 per month (adjusted odds ratio [AOR] = 1.73, 95% confidence interval [CI]: 1.04-2.87), less than 8 years of education (AOR = 2.21, CI: 1.38-3.53), a greater sense of vulnerability (AOR = 2.58, CI: 1.54-4.33), a willingness to participate in vaccine trials (AOR = 1.91, CI: 1.20-3.05), and use of crack/cocaine (AOR = 1.91, CI: 1.05-3.46). Our findings suggest that HIV prevention programs for these men need to address drug use and how drug use may influence sexual behaviors.
Asunto(s)
Cocaína Crack , Homosexualidad Masculina , Conducta Sexual , Factores Socioeconómicos , Abuso de Sustancias por Vía Intravenosa/epidemiología , Adolescente , Adulto , Brasil/epidemiología , Estudios de Cohortes , Seronegatividad para VIH , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Asunción de Riesgos , Encuestas y CuestionariosRESUMEN
OBJECTIVES: In preparation for a phase III HIV vaccine trial, we report the results of men who have sex with men (MSM) cohort ('Projecto Rio'). METHODS: HIV-negative MSM were followed 6-monthly over a 3-year period. RESULTS: High seroprevalence for sexually transmitted disease (HIV, syphilis and hepatitis B seropositivities of 24%, 29%, and 37%, respectively) was seen in the 1165 potential volunteers, and this seroprevalence showed significant differences according to HIV serologic status. Among the 647 HIV-negative cohort participants, HIV incidence rate (IR) was 3.33 (95% CI 1.93-4.67) per 100 men-years, with 21 newly acquired HIV infections during 7572 men-months of observation. IR differences were observed in four categories: (1) non-commercial sex workers and non-transvestites who had protected sex prior to study entry (IR 1.6 per 100 men-years); (2) non-commercial sex workers and non-transvestites who had unprotected sex prior to study entry (IR 2.7 per 100 men-years); (3) commercial sex workers (IR 3.5 per 100 men-years); and (4) transvestite groups (IR 16.8 per 100 men-years). Unprotected penetrative anal sex was frequent (66%) in the 6 months before study entry, and when we take into consideration the fact that bisexual men engaged in unprotected vaginal intercourse with their female partners, the risk behavior in this group escalates to 73%. HIV seroconverters had high risk behavior prior to study entry (76%), and all but one admitted to having unprotected penetrative sex prior to infection. CONCLUSIONS: MSM in this study had a high rate of unprotected penetrative sexual practices, which caused a significant HIV incidence rate, and, with improved study adherence, this study site could be used for future vaccine trials.