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IJE Advance Access published online on July 29, 2008
International Journal of Epidemiology, doi:10.1093/ije/dyn151
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Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2008; all rights reserved.
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org

Systematic review of orogenital HIV-1 transmission probabilities

Rebecca F Baggaley1,*, Richard G White2 and Marie-Claude Boily1

1 Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, UK.
2 Infectious Disease Epidemiology Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.

* Corresponding author. Department of Infectious Disease Epidemiology, Imperial College London, St Mary's Campus, Norfolk Place, Paddington, London W2 1PG, UK. E-mail: r.baggaley{at}imperial.ac.uk


  Abstract

Background The objective was to assess the risk of HIV transmission from orogenital intercourse (OI).

Methods Systematic review of the literature on HIV-1 infectiousness through OI conducted according to MOOSE guidelines for reviews of observational studies. The PubMed database and bibliographies of relevant articles were searched to July 2007.

Results Of the titles, 56 214 were searched from which 10 potentially appropriate studies were identified; two additional studies were identified through bibliographies and one through discussion with experts. There were 10 included studies, providing estimates of transmission probabilities per-partner (n = 5), incidence per-partner (n = 3), per-study participant (n = 3, following initially seronegative individuals whose partners are of unknown serostatus) and per-act (n = 3). Only four of 10 studies reported non-zero estimates: two per-partner estimates (20%, 95% CI: 6–51, n = 10 and a model-based estimate, 1%, range 0.85–2.3%), one per-study participant estimate (0.37%, 95% CI: 0.10–1.34%) and one per-act estimate (0.04%, 95% CI: 0.01–0.17%). Upper bounds for the 95% CI for zero estimates tended to be relatively large due to the small study sample sizes: 9.0, 12.1 and 2.8% for per-partner; 4.7, 9.6 and 1.8 per 100 person-years for incidence per-partner; 4.4% per-study participant and 0.45 and 0.02% for per-act. Given the small number of studies, a meta-analysis was not considered appropriate.

Conclusions There are currently insufficient data to estimate precisely the risk from OI exposure. The low risk of transmission evident from identified studies means that more and larger studies would be required to provide sufficient evidence to derive more precise estimates.

Keywords HIV, oral sex, orogenital intercourse, infectivity, transmission probability

Accepted 23 June 2008


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