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October 14, 1992

Female-to-Male Transmission of HIV-Reply

Author Affiliations

University of California, San Francisco
University of California, Berkeley

JAMA. 1992;268(14):1856-1857. doi:10.1001/jama.1992.03490140063025

In Reply.  —Population-based generalizations from partner studies often are inappropriate. Partner studies evaluate the risk of transmission due to exposure rather than likelihood of exposure, so they cannot estimate frequency of transmission in populations as Drs Haverkos and Battjes implicitly propose. Likewise, because the distribution of known and unknown cofactors varies across study samples, one would expect heterogeneous transmission rates.Another difference among studies could stem from how effectively the mode of transmission is ascertained. Although in their study De Vincenzi and Ancelle-Park report no differences in transmission rates according to the risk group of the index case,1 68% of the female-to-male cases observed occurred among the partners of intravenous drug users (IVDU). It is often difficult to rule out drug use in sexual partners of IVDUs, making it problematic both to control for nonsexual exposures and to determine the true index case. Thirteen of the 14 concordant couples