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Only one fifth or fewer of the female sexual partners of HIV-1-infected men with hemophilia become infected. The risk factors associated with heterosexual transmission of HIV-1 are not well understood. To investigate the hypothesis that HIV-1 viral load may be related to heterosexual HIV-1 transmission, we measured HIV-1 RNA by polymerase chain reaction (PCR) in frozen samples from 39 men with hemophilia and HIV-1 infection obtained between 20 and 62 months after HIV-1 seroconversion, during at least a 6-month relationship with a female sexual partner. The median time from the hemophilic viral load determination to the estimated date of transmission to the female partner was 9 months (range, 4-41 months). The proportion of HIV-positive hemophilic men with >100,000 HIV RNA copies/ml was significantly higher in transmitters (TR) (3 of 5 60%), than in nontransmitters (NTR) (3 of 34 9%; p = 0.027). There were no differences between TR and NTR in age at seroconversion (32.4 years each), in time from seroconversion to AIDS (67 versus 79 months), in mean CD4 number (245/microl] versus 260/microl); nor in the proportion who developed AIDS (4 of 5 80% versus 24 of 34 71%). These findings appear to suggest that high HIV viral load in HIV-infected hemophilic men increases the risk of HIV transmission to heterosexual partners. Viral load determinations may be helpful in counseling hemophilic couples regarding transmission to female partners.
Ragni et al. (Thu,) studied this question.