Risk probability hiv activities5/6/2023 Third, we reviewed the resulting abstracts to identify articles that mentioned HIV transmission or any type of transmission risk estimate, or described models that were used to generate these estimates, both among serodiscordant couples and MSM. We also contacted subject matter experts to ascertain whether other studies or unpublished data of which we were unaware existed. For the exposures for which there were no recent reviews or meta-analyses, we reviewed the literature cited in CDC’s last summary and the 2011 British Pre-exposure Prophylaxis Guidelines. We used the results of this literature search to ensure that the above-mentioned meta-analyses were up to date. We highlighted data from developed regions to more closely reflect the US epidemic this strategy was consistent with that used for the relevant meta-analyses, which did not pool data from developed and developing countries due to heterogeneity among studies, except for the per-act HIV-transmission risk from parenteral exposures, which is less geographically dependent. We used the following search string: and and. We searched for human studies published in English language only between 1 January 2008 and 22 February 2012 within the following databases: Medline (Ovid), Embase (Ovid), CINAHL (EbscoHost), Web of Science, Global Health, and the Cochrane Library. Second, we conducted a literature search to identify data published after the publications noted above. We then reviewed the 2011 British Pre-exposure Prophylaxis Guidelines, which provided a summary table of per-act HIV transmission risks using estimated medians and ranges based largely on the results of the meta-analyses noted above. Each of these peer-reviewed studies included a comprehensive literature review and employed accepted and robust meta-analytic methods. First, we established what was already known, starting with a series of recent systematic reviews and meta-analyses that were identified through a comprehensive literature review conducted for a related project that also examined per-act HIV transmission risk and provided estimates of pooled per-act HIV transmission probabilities for blood transfusion, parenteral exposures, receptive anal intercourse, receptive penile–vaginal intercourse, insertive penile–vaginal intercourse, and mother-to-child transmission. We conducted a five-step process of literature search and review. Therefore, we have also summarized the relative effects of factors that modify per-act transmission risks, such as condom use and antiretroviral therapy, and have examined their individual and combined effects on per-act infectivity for high-risk sexual exposures. These transmission estimates may not reflect true infectivity and may obscure important differences associated with factors that may modify transmission risk. Thus, we have updated our estimates of per-act HIV transmission risks from an infected source to an HIV-uninfected person for parenteral, vertical, and sexual exposures. Additionally, the published literature quantifying the effects of modifying factors known to either increase or decrease transmission risk has expanded substantially. Since 2005, new data have been reported from cohort studies of heterosexuals and of MSM, and new systematic reviews and meta-analyses of certain transmission risks have been published. When the Centers for Disease Control and Prevention (CDC) last produced estimates in 2005, many per-act transmission probabilities for sexual exposures relied heavily on estimates derived from a single study of heterosexual couples. Accurate estimates of per-act HIV transmission risk from various exposures are necessary for individuals and public health programs to prevent infection.
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