To estimate the HIV incidence and assess the behavioral, clinical, and quality-of-life risk factors for HIV transmission among serodiscordant couples from Henan Province, China. Between January and Decemberinitially seronegative spouses were tested for HIV at six month intervals.
Retrospectively identified subjects were interviewed through face-to-face questionnaire. Cox proportional-hazards model was used to assess the relationship between risk factors and HIV seroconversion.
Out of couples, 84 4. Seroconversion rates increased over time. Seventy one percent "Discordant couples and hiv transmission heterosexual" index spouses were on ART.
There was association between rate of HIV seroconversion and last recorded CD4 cell count level of the index spouse. Effective HIV prevention interventions targeting discordant couples should focus on sustaining health education, increasing psychosocial support services, and increasing medication adherence monitoring. While many studies attempting to quantify HIV incidence among discordant couples have been conducted globally, few have been conducted outside of Africa, 6 — 9 and to our knowledge, none from China have been published in English.
The only other Chinese study had a small sample size 22 and was conducted in Xinjiang province, where IDU is the main mode of transmission. Most became infected through the sale of plasma between and Local staff enrolled study participants at county hospitals, at community health centers, or at home residences using the following inclusion criteria: The primary outcome was HIV seroconversion. We defined seroconverter as an individual who had a negative HIV test before entering the cohort and subsequently had a positive HIV test during follow-up.
Time of seroconversion was estimated as the midpoint between the last HIV negative test and the first HIV positive test. A standardized questionnaire was administered in Chinese by trained local healthcare workers to initially HIV-negative spouses between October and May Survey questions included information on demographic characteristics, sexual activity, condom use, quality of life, STI history, as well as medical history of their HIV positive spouses.
If subjects had seroconverted during follow-up, they were asked to report sexual behaviors in the month s "Discordant couples and hiv transmission heterosexual" to their first HIV positive test.
This instrument has been previously described and validated in patients with HIV. Scores for each domain ranged from 4 to 20, with higher scores indicating better functional status. All participants were given pre-test and post-test counseling and HIV-positive subjects were referred to the Zhumadian CDC for free counseling and evaluation for treatment.
Statistical analysis was performed using SPSS Continuous variables were described using mean and standard deviation. Cox proportional-hazard modeling was used to assess the relationship between seroconversion and potential risk factors. Subjects that never seroconverted or were lost-to-follow-up in December were censored.
Univariate Cox models were run to assess the unadjusted relationship between seroconversion and specified covariates of interest for all subjects. Survival time was defined as the time from baseline to when the initially HIV-negative spouse was confirmed positive or censored. All hypothesis testing based on 2-sided tests with alpha level of 0.
By December 31,more serodiscordant couples were identified. Baseline characteristics of study participants and non-participants were comparable in terms of age and sex. Of those who participated, Their average age was One thousand and nineteen were of Han ethnicity One thousand seven hundred and forty one Over 3 years, there were 84 seroconversions among 1, serodiscordant couples.
The total follow-up time was person-years median 2. There was no statistical difference between the male and female seroconversion rates at 1. Figure 1 shows the cumulative and interval seroconversion rates expressed as a function of follow-up time. As length of follow-up increases, so does the interval seroconversion rate Figure 1. In the past 3 months, 1, The reported mean frequency of intercourse was 3.
Compared with those who did not seroconvert, those who seroconverted were more likely to have reported having sexual intercourse in the past 3 months Seven hundred and thirty-five spouses who were HIV-negative at baseline reported having sex less than 4 times per month and spouses reported having sex 4 times or more per month.
Spouses reporting more frequent sex were 5. Compared with couples who reported always used condoms Spouses reported the following reasons for not always using condoms: Only 7 people reported having extra-marital sexual relationships in the past year and only one of these seroconverted. One person reported a history of drug abuse and this individual did not seroconvert. None of the surveyed men reported ever having sex with another man. Cumulative Survival indicates the proportion of people who have not seroconverted.
Life table survival stratified by frequency of sex in the past month. Life table survival stratified by consistency of condom use. Life table survival stratified by quality-of-life score in the psychological domain. There were 73 seroconversions among the 1, serodiscordant couples that had a spouse with a clinical diagnosis of AIDS.
Out of 1, individuals receiving ART, had switched regimens and had never switched. Clinicians reported that most people regimens due to adverse side effects Among other reasons for stopping or switching regimens: Of the patients who did not switch ART and had a recorded CD4 count, the overall transmission rate was 2.
Out of patients who had switched ART and had a CD4 count, Discordant couples and hiv transmission heterosexual overall rate of transmission was 1. HIV-negative spouses had a mean physical domain score of There were no statistical differences in the quality of life scores of those who seroconverted when compared to those who did not seroconvert.
In Discordant couples and hiv transmission heterosexual analysis, this association remained significant for the psychological domain but not for the physical domain Table 1. Our study of HIV discordant couples in Zhumadian city, Henan province is the largest of its kind in China and found an incidence rate of 1.
The only other study of discordant couples in China was conducted in Xinjiang province, but had a sample size of only The overall seroconversion rate also showed an increasing upward trend as the duration of follow-up lengthened.
There are several possibilities for why this occurred. First, chronically-HIV
Discordant couples and hiv transmission heterosexual patients may undergo immunologic failure, virologic failure, advance to later stages of disease, or acquire resistance, leading to higher rates of transmission over time. Our study found no statistical difference between the male-to-female transmission and female-to-male transmission rates. These results are consistent with several other studies of discordant couples from Brazil, Haiti, Tanzania, Rwanda, Uganda, and India.
Although the literature has been inconclusive, one large prospective study from Masaka region Uganda attributed the age-adjusted RR for infection for women of 2.