HIV Incidence and Predictors of HIV Acquisition From an Outside Partner in Serodiscordant Couples in Lusaka, Zambia

Abstract

Objective Evaluate the incidence and predictors of HIV acquisition from outside partners in serodiscordant couples. Methods Demographic, behavioral, and clinical exposures were measured quarterly in a cohort of serodiscordant cohabiting couples in Zambia from 1995-2012 (n=3049). Genetic analysis classified incident infections as those acquired from the study partner (linked) or acquired from an outside partner (unlinked). Factors associated with time to unlinked HIV infection were evaluated using multivariable Cox proportional hazards regression stratified by gender. Results There were 100 unlinked infections in couples followed for a median of 806 days. Forty-five infections occurred in women (1.85/100 couple-years [CY]; 95%CI:1.35-2.47). Risk of female unlinked infection (vs. non-seroconverting females) was associated with reporting being drunk weekly/daily vs. moderate/non-drinkers at baseline (aHR=5.44;95%CI:1.03-28.73), genital ulcers (aHR=6.09;95%CI:2.72-13.64) or genital inflammation (aHR=11.92;95%CI:5.60-25.37) during follow-up adjusting for age, years cohabiting, income, contraceptive use, previous pregnancies, history of sexually transmitted infections (STI), and condomless sex with study partner. Fifty-five infections occurred in men (1.82/100 CY;95%CI:1.37-2.37). Risk of male unlinked infection was associated with genital inflammation (aHR=8.52;95%CI:3.82-19.03) or genital ulceration (aHR=2.31;95% CI:2.05-8.89), reporting =>1 outside sexual partner (aHR=3.86;95%CI:0.98-15.17) during follow-up, and reporting being drunk weekly/daily vs. moderate/non-drinkers at baseline (aHR=3.84;95%CI=1.28-11.55), controlling for age, income, circumcision status, and history of STI. Conclusions Predictors of unlinked infection in serodiscordant relationships were alcohol use, genital inflammation, and ulceration. Causes of genital inflammation and ulceration should be screened for and treated in HIV-negative individuals. Counseling on risk of alcohol use and sex with outside partners should be discussed with couples where one or both are HIV-negative, including in counseling on use of pre-exposure prophylaxis to prevent HIV acquisition in the HIV-negative partner.

Prevalence and correlates of sexually transmitted infections in pregnancy in HIV-infected and- uninfected women in Cape Town, South Africa

“…Of those who tested positive, 31% were co-infected with more than one STI. Odds of having a STI were higher in HIV-infected women, especially in partnerships in which the woman reported being in a concordant HIV-positive couple, consistent with research that suggests a complex relationship between HIV-infected women’s sexual behavior as well as their genital tract infections and increased risk of HIV acquisition [6–11]. Importantly, the vast majority of STIs diagnosed in participants were asymptomatic, and the sensitivity of syndromic management was only 35%.…”

“…HIV-uninfected women who have a STI are also at increased risk of HIV acquisition [10, 11]. Because the mechanisms of STI and HIV acquisition are so tightly linked, interventions developed to address primary HIV prevention in pregnancy should also address screening and treatment of STIs in pregnancy.…”

“…Genital tract infections not only disrupt the protective mucosal barrier but increase the release of specific inflammatory cytokines linked to HIV acquisition [8, 9]. In HIV-uninfected women, STIs increase the risk of HIV acquisition [10, 11] and high viral load can significantly increase the risk of vertical HIV transmission [12].…”

Assessment of syndromic management of curable sexually transmitted and reproductive tract infections among pregnant women: an observational cross-sectional study

“…Syphilis ( Treponema pallidum ) is associated with four of every ten spontaneous abortions [ 5 , 6 ], and one-quarter of stillbirths [ 7 ]. Pregnant women who have curable STIs are at elevated risk of HIV acquisition during pregnancy [ 8 , 9 ], whereas HIV-infected pregnant women who have curable STIs at delivery are at increased risk of giving birth to an HIV-infected infant [ 10 ].…”

Knowledge of HIV status and antiretroviral therapy use among sexually transmitted infections service attendees and the case for improving the integration of services in South Africa

“…Biologically, STIs may result in genital inflammation and higher viral loads and so facilitate the transmission of HIV from an infected partner to an uninfected partner. [ 1 – 3 ] On the other hand, HIV alters the natural history of some STIs with a tendency towards severe symptoms and slower resolution following treatment. [ 4 – 6 ] Acute HIV infection may present with genital symptoms making STI services a good platform to identify individuals with early HIV infection for rapid initiation on antiretroviral therapy.…”