Abstract
BackgroundHIV-1-discordant couples that remain discordant despite repeated exposure may differ from the general population in their distribution of transmission risk factors, including low plasma viral load (PVL) in the infected partner even in the absence of antiretroviral therapy (ART).MethodsWe followed two cohorts of HIV-1-infected Kenyan women: females in discordant couples (FDC) and female sex workers (FSW). We compared the distribution of undetectable (<150 copies/mL) and low PVL (<1,000 copies/mL) between the cohorts using bootstrap methods and exact Poisson regression.ResultsWe evaluated 296 FDC and 220 FSW. At baseline, FDC were more likely to have undetectable (RR = 6.94, bootstrap 95% CI: 3.47, 20.81) and low PVL (RR = 3.53, bootstrap 95% CI: 2.57, 5.65) than FSW. Similarly, both repeat undetectable PVL (RR = 9.36, bootstrap 95% CI: 6.04, 10.97) and repeat low (RR = 4.99, bootstrap 95% CI: 2.33, 14.04) PVL were more likely among FDC than FSW during follow-up.DiscussionWe observed higher prevalence of viral control in FDC compared to FSW in the absence of ART, suggesting potentially higher prevalence of biological HIV resistance factors among discordant couples.
Highlights
HIV-1-discordant couples, of whom one partner is HIV-positive and the other is HIV-negative, have been identified as a priority population for preventing the onward transmission of HIV, leading to expansion of treatment for people living with HIV in a discordant partnership in many countries, as well as targeted provision of pre-exposure prophylaxis to HIV-negative persons in a discordant couple
females in discordant couples (FDC) were more likely to have undetectable (RR = 6.94, bootstrap 95% CI: 3.47, 20.81) and low plasma viral load (PVL) (RR = 3.53, bootstrap 95% CI: 2.57, 5.65) than female sex workers (FSW)
Both repeat undetectable PVL (RR = 9.36, bootstrap 95% CI: 6.04, 10.97) and repeat low (RR = 4.99, bootstrap 95% CI: 2.33, 14.04) PVL were more likely among FDC than FSW during follow-up
Summary
HIV-1-discordant couples that remain discordant despite repeated exposure may differ from the general population in their distribution of transmission risk factors, including low plasma viral load (PVL) in the infected partner even in the absence of antiretroviral therapy (ART). Data Availability Statement: Data cannot be shared publicly due to requirements from the Kenyatta National Hospital/University of Nairobi Ethics and Research Committee that we release data from Kenyan studies (including de-identified data) only after they have provided their written approval for additional analyses. They do not feel that analyses that may be outside the scope of the current scientific and ethical approval should be conducted without their prior review. The Principal Investigator on the approved protocol is considered to be the custodian of the data.
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