{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T11:13:32Z","timestamp":1791890012379,"version":"4.3.4"},"reference-count":31,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2018,9,2]],"date-time":"2018-09-02T00:00:00Z","timestamp":1535846400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R01AI057020"],"award-info":[{"award-number":["R01AI057020"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["NIH UM1 AI068617"],"award-info":[{"award-number":["NIH UM1 AI068617"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["American J Rep Immunol"],"published-print":{"date-parts":[[2018,11]]},"abstract":"\n Quantifying\n HIV<\/jats:styled-content>\n \u20101 transmission risk per\u2010act of anal intercourse (\n AI<\/jats:styled-content>\n ) is important for\n HIV<\/jats:styled-content>\n \u20101 prevention. We updated previous reviews by searching Medline and Embase to 02\/2018. We derived pooled estimates of receptive\n AI<\/jats:styled-content>\n (\n URAI<\/jats:styled-content>\n ) and insertive\n AI<\/jats:styled-content>\n (\n UIAI<\/jats:styled-content>\n ) risk unprotected by condoms using random\u2010effects models. Subgroup analyses were conducted by gender, study design, and whether antiretroviral treatment (\n ART<\/jats:styled-content>\n ) had been introduced by the time of the study. Two new relevant studies were identified, one of which met inclusion criteria, adding three new cohorts and increasing number of individuals\/partnerships included from 1869 to 14\u00a0277. Four studies, all from high\u2010income countries, were included. Pooled\n HIV<\/jats:styled-content>\n \u20101 risk was higher for\n URAI<\/jats:styled-content>\n (1.25%, 95%\n CI<\/jats:styled-content>\n 0.55%\u20102.23%, N\u00a0=\u00a05,\n I<\/jats:italic>\n 2<\/jats:sup>\n \u00a0=\u00a087%) than\n UIAI<\/jats:styled-content>\n (0.17%, 95 %\n CI<\/jats:styled-content>\n 0.09%\u20100.26%, N\u00a0=\u00a03,\n I<\/jats:italic>\n 2<\/jats:sup>\n \u00a0=\u00a00%). The sole heterosexual\n URAI<\/jats:styled-content>\n estimate (3.38%, 95%\n CI<\/jats:styled-content>\n 1.85%\u20104.91%), from a study of 72 women published in a peer\u2010reviewed journal, was significantly higher than the men\u2010who\u2010have\u2010sex\u2010with\u2010men (MSM) pooled estimate (0.75%, 95%\n CI<\/jats:styled-content>\n 0.56%\u20100.98%, N\u00a0=\u00a04,\n P<\/jats:italic>\n \u00a0<\u00a00.0001) and higher than the only other heterosexual estimate identified (0.4%, 95%\n CI<\/jats:styled-content>\n 0.08%\u20102.0%, based on 59 women, excluded for being a pre\u20102013 abstract). Pooled per\u2010act\n URAI<\/jats:styled-content>\n risk varied by study design (retrospective\u2010partner studies: 2.56%, 95%\n CI<\/jats:styled-content>\n 1.20%\u20104.42%, N\u00a0=\u00a02 (one\n MSM<\/jats:styled-content>\n , one heterosexual); prospective studies: 0.71%, 95%\n CI<\/jats:styled-content>\n 0.51%\u20100.93%, N\u00a0=\u00a03\n MSM<\/jats:styled-content>\n ,\n P<\/jats:italic>\n \u00a0<\u00a00.0001).\n URAI<\/jats:styled-content>\n risk was lower for studies conducted in the\n ART<\/jats:styled-content>\n era (0.75%, 95%\n CI<\/jats:styled-content>\n 0.52%\u20101.03%) than pre\u2010\n ART<\/jats:styled-content>\n (1.67%, 95%\n CI<\/jats:styled-content>\n 0.44%\u20103.67%) but not significantly so (\n P<\/jats:italic>\n \u00a0=\u00a00.537). Prevention messages must emphasize that\n HIV<\/jats:styled-content>\n \u20101 infectiousness through\n AI<\/jats:styled-content>\n remains high, even in the\n ART<\/jats:styled-content>\n era. Further studies, particularly among heterosexual populations and in resource\u2010limited settings, are required to elucidate whether\n AI<\/jats:styled-content>\n risk differs by gender, region and following population\u2010level\n ART<\/jats:styled-content>\n scale\u2010up.\n <\/jats:p>","DOI":"10.1111\/aji.13039","type":"journal-article","created":{"date-parts":[[2018,9,3]],"date-time":"2018-09-03T00:28:31Z","timestamp":1535934511000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":50,"title":["Does per\u2010act\n HIV<\/scp>\n \u20101 transmission risk through anal sex vary by gender? An updated systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"80","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4688-3924","authenticated-orcid":false,"given":"Rebecca F.","family":"Baggaley","sequence":"first","affiliation":[{"name":"Department of Infectious Disease Epidemiology Imperial College London London UK"},{"name":"Department of Global Health and Development London School of Hygiene and Tropical Medicine London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Branwen N.","family":"Owen","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology Imperial College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romain","family":"Silhol","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology Imperial College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2097-5465","authenticated-orcid":false,"given":"Jocelyn","family":"Elmes","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology Imperial College London London UK"},{"name":"Department of Global Health and Development London School of Hygiene and Tropical Medicine London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Anton","sequence":"additional","affiliation":[{"name":"Department of Medicine UCLA Center for HIV Prevention Research David Geffen School of Medicine at UCLA UCLA AIDS Institute Los Angeles California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6470-8476","authenticated-orcid":false,"given":"Ian","family":"McGowan","sequence":"additional","affiliation":[{"name":"University of Pittsburgh School of Medicine Pittsburgh Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariane","family":"van der Straten","sequence":"additional","affiliation":[{"name":"Women's Global Health Imperative RTI International San Francisco California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7067-732X","authenticated-orcid":false,"given":"Barbara","family":"Shacklett","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Immunology School of Medicine University of California Davis Davis California"},{"name":"Division of Infectious Diseases Department of Medicine School of Medicine University of California Davis Sacramento California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Que","family":"Dang","sequence":"additional","affiliation":[{"name":"Vaccine Research Program Division of AIDS National Institutes of Health Bethesda Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edith M.","family":"Swann","sequence":"additional","affiliation":[{"name":"Vaccine Research Program Division of AIDS National Institutes of Health Bethesda Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1897-499X","authenticated-orcid":false,"given":"Diane L.","family":"Bolton","sequence":"additional","affiliation":[{"name":"U.S. Military HIV Research Program The Henry M. Jackson Foundation Walter Reed Army Institute of Research Silver Spring Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3919-006X","authenticated-orcid":false,"given":"Marie\u2010Claude","family":"Boily","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology Imperial College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,9,2]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-015-0997-y"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.7448\/IAS.20.1.21162"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwx244"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000000298"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyq057"},{"key":"e_1_2_7_7_1","unstructured":"HalperinDT ShiboskiSC PalefskySC PadianNS.High level of HIV\u20101 infection from anal intercourse: a neglected risk factor in heterosexual AIDS prevention. 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