Evidence of zero-risk transmission of HIV in the era of antiretroviral therapy: A systematic review and meta-analyses

Abstract

Objective

This systematic review aimed to assess the evidence on sexual transmission of HIV in high-income settings between serodiscordant couples where the index partner infected with HIV is on antiretroviral therapy.

Study design

Systematic review and meta-analyses.

Methods

We performed a systematic search in four databases: Embase, MEDLINE, The Cochrane Library, and Web of Science on September 24, 2022. We assessed the risk of bias with ROBINS-I and pooled estimates in meta-analyses using a Poisson regression model with a random effect of the study and population size. The study protocol was pre-registered at PROSPERO. The study involved high-income countries.

Results

The search identified 6886 studies, of which six were included for review. Altogether, studies reported zero linked transmissions among 2383 couples, more than 160,000 acts of intercourse, and 3578 couple years. The risk estimate from overall meta-analyses was 0.000 95%CI (0.000–0.103) per 100 couple-years.

Conclusion

This systematic review and meta-analyses provide epidemiological evidence for a low risk of HIV transmission under antiretroviral therapy in high-income countries and thus cannot reject the theoretical "treatment as prevention" paradigm.