Abstract
There is considerable variability between individuals in susceptibility to infection by human immunodeficiency virus (HIV). Many social, clinical and genetic factors are known to contribute to the likelihood of HIV transmission, but there is little consensus on the relative importance and potential interaction of these factors. Additionally, recent studies of several variants in chemokine receptors have identified alleles that may be predictive of HIV transmission and disease progression; however the strengths and directions of the associations of these genetic markers with HIV transmission have markedly varied between studies. To better identify factors that predict HIV transmission in a Chinese population, 180 cohabiting serodiscordant couples were enrolled for study by the Henan Center for Disease Prevention and Control, and transmission and progression of HIV infection were regularly measured. We found that anti-retroviral therapy, education level, and condom use were the most significant factors in determining likelihood of HIV transmission in this study. We also assessed ten variants in three genes (CXCL12, CCR2, and CCR5) that have been shown to influence HIV transmission. We found two tightly linked variants in CCR2 and CCR5, rs1799864 and rs1800024, have a significant positive association with transmission as recessive models (OR>10, P value=0.011). Mixed effects models showed that these genetic variants both retained significance when assessed with either treatment or condom use. These markers of transmission susceptibility may therefore serve to help stratify individuals by risk for HIV transmission.
Highlights
Human immunodeficiency virus infection/ acquired immunodeficiency syndrome (HIV/ AIDS) has the highest mortality among infectious diseases in China and has become a public health crisis
The male/female ratios of index partners are 42/45 and 53/40 for the transmission group and non-transmission group, respectively. 79 of 87 and 72 of 93 index partners received anti-retroviral therapy (ART) in the transmission and nontransmission groups, Fisher exact test showed that reception of ART positively associated with risk of human immunodeficiency virus (HIV) transmission within couples (P = 0.025)
The most significant factor associated with transmission is condom use, with both the frequency of usage before and after the diagnosis of the index partner for HIV infection having a significant negative association with transmission
Summary
Human immunodeficiency virus infection/ acquired immunodeficiency syndrome (HIV/ AIDS) has the highest mortality among infectious diseases in China and has become a public health crisis. In response to this health challenge, since 2003 the national government has offered a free antiretroviral treatment and prevention program. A 2011 joint assessment by the World Health Organization, UNAIDS, and the Chinese Ministry of Health found there remained about 780 000 people infected with HIV in China, with approximately 154,000 cases of AIDS Within this cohort, more than 60% of transmissions occurred heterosexually, the remaining transmissions were due to intravenous drug use, blood transfusions, mother to child transmission, and male-to-male sexual contact [1]. Cohabiting serodiscordant couples (HIV infected individuals with uninfected partners of opposite sex) are at an especial high risk of transmission
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