Risk factors for HIV transmission among heterosexual discordant couples in South India^*

Abstract

ObjectiveTo assess the risk factors associated with heterosexual HIV transmission among South Indian discordant couples enrolled in clinical care. MethodsA nested matched case-control study of serodiscordant couples in which the HIV-infected partner (index case) was enrolled in care. Demographic and clinical characteristics, sexual behaviours, CD4 cell count and plasma HIV-1 RNA loads were measured at enrolment and longitudinally over 12 months of follow-up. The study included 70 cases who seroconverted during study follow-up and 167 matched controls who remained persistently serodiscordant. ResultsThe incidence of HIV infection among the initially seronegative partners was 6.52 per 100 personyears. Persistently discordant patients were more likely to have initiated highly active antiretroviral therapy (HAART) than patients in seroconverting relationships (62.9% vs. 42.9%) (P50.001). Patients in seroconverting relationships had significantly higher plasma viral loads (PVLs) than patients in discordant relationships at enrolment, at 6 months and at 12 months (Po0.05). Patients in seroconverting relationships were less likely to use condoms with their primary partners than patients in discordant relationships (Po0.05). Patients in relationships that seroconverted between 6 and 12 months were diagnosed more often with genital Herpes simplex than patients in discordant relationships (P50.001). In the univariate and multivariate logistic regression, the following variables were associated with seroconversion: PVL 4100 000 [odds ratio (OR): 1.82; 95% confidence interval (CI): 1.1-2.8], non-disclosure of HIV status (OR: 5.5; 95% CI: 4.3-6.2) and not using condoms (OR: 2.8; 95% CI: 2.4-3.6). ConclusionsCouples-based intervention models are crucial in preventing HIV transmission to seronegative spouses. Providing early treatment for sexually transmitted infections, HAART and enhancing condom use and disclosure could potentially decrease the risk of HIV transmission within Indian married couples. IntroductionAn increasing focus of HIV preventive strategies has been to move away from solely reducing the risk-taking behaviours of HIV-uninfected individuals to focusing on HIV-infected individuals who may continue to practice HIV risk-taking behaviours [1]. Studies from the developed and developing world have documented that a sizeable number of HIV-infected individuals continue to engage in unprotected sexual intercourse with HIV-serodiscordant partners [2][3][4][5][6]. Unprotected intercourse may be more common among HIV-infected individuals in steady or regular relationships than in casual or non-regular sexual *The first two authors contributed equally to this manuscript. [19]. The typical route of HIV transmission has been through unprotected heterosexual intercourse [20]; however, data about the incidence and risk factors associated with HIV transmission through heterosexual intercourse in India remains very limited [21]. The social construct of gender in India, which has evolved over many centuries, makes women highl...

Understanding HIV disclosure: A review and application of the Disclosure Processes Model

“…As our review notes, extant literature examines disclosure to a vast array of types of confidants, including sexual partners (Kumarasamy et al, 2010), family and friends (Rice et al, 2009), medical providers (Jeffe et al, 2000), and children (Palin et al, 2009), and our review integrates findings across these confidants. Although we do focus on the effect of confidant relationship as an antecedent factor, there may be other ways in which disclosure to these confidants may differ.…”

Community Viral Load and CD4 Count Distribution Among People Living With HIV in a South African Township

“…HIV RNA level is the single most important predictor of HIV transmission [13,14,15]. A study from Rakai, Uganda, reported that there were no instances of HIV transmission between sero-discordant couples when serum HIV RNA levels in the infected partner were ≤1500 copies/ml [13].…”

Clinico-Epidemiological Profile of Viral Sexually Transmitted Infections in Seropositive Patients Attending a Tertiary Care Hospital in North India

“…6,8,12,27,[30][31][32] This has clinical implications as recent studies have shown that the risk of seroconversion in HIV-discordant couples is more in patients with genital herpes, thereby stressing the need for effective alternative treatment modalities such as cidofovir, imiquimod, and foscarnet in seropositive patients. 7,16 Growths: Genital Warts Genital warts occur with increased frequency in seropositive patients, especially in men who have sex with men (MSMs) and with decreasing CD4 counts. [33][34][35][36] In our study, the size and extent of lesions including perianal (50%) and extragenital (37.5%) involvement were significantly commoner in the seropositive patients (Figure 2).…”

“…1,2 This mutual interaction between HIV and STD can profoundly affect the transmission dynamics of HIV. [3][4][5][6][7][8] These STDs present with atypical clinical manifestations in seropositive patients with extensive, persistent involvement, altered morphology, and coexistence of multiple sexually transmitted infections (STIs). [1][2][3]5,6,8 In countries like India, where there is high prevalence of STIs, targeted STD detection and treatment especially in seropositive patients may have a central role in reducing HIV burden as suggested by randomized controlled intervention trials.…”

“…[1][2][3]5,6,8 In countries like India, where there is high prevalence of STIs, targeted STD detection and treatment especially in seropositive patients may have a central role in reducing HIV burden as suggested by randomized controlled intervention trials. 2,5,7,9 The current program, National AIDS Control Programme-IV (NACP-IV), 2012 to 2017, aims to reduce annual new HIV infections by 50% through targeted interventions for key affected groups with high risk of transmission (patients with STI). 9 There is a general consensus that the bacterial STDs (chancroid, donovanosis, and gonorrhea) are declining possibly because of the widespread use of effective antimicrobials, while the prevalence of viral STDs is increasing.…”