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Unanswered Questions

Posted by rsvanhowe on 20 Jul 2011 at 16:26 GMT

To the Editor:

The authors are to be congratulated on their research; however, questions remain unanswered. It is not clear why the sexually transmission of HIV is so inefficient compared to other sexually transmitted infections or why viral load would be a factor. While this study helps explain how HIV can be sexually transmitted, it doesn’t explain why it so rarely is. The correlation to viral load suggests that the mucosal immunity is effective unless overwhelmed by numbers of virus-infected cells. Perhaps the focus should be expanded to include studying what is working, such as ways of increasing the amount of langerin on the mucosal surface. I believe that the biological answer to sexually transmitted HIV infections lies in ramping up mucosal immunity, not cutting it off. The glans has a higher concentration of Langerhans cells than the inner foreskin, so transmission will continue to take place. The data reported in the randomized controlled trials of male circumcision in Africa indicate that half of the infections they documented can be attributed to non-sexual transmission, making the validity of these studies suspect. Iatrogenic infections account for the high prevalence of HIV infections in Africa. It is likely that various circumcision proponents will use the results of this study to validate their beliefs, but it must be remembered that the transmission rates of HIV through sexual contact are low, sexual transmission can be nearly eliminated through condom use, and a solution using mucosal immunity is on the horizon.

No competing interests declared.