Abstract
BackgroundEarly initiation of antiretroviral therapy reduces risk of transmission to the uninfected partner in HIV discordant couples, but there are relatively little observational data on HIV transmission within couples from non-trial settings. The aims of this paper are to estimate HIV incidence among HIV discordant couples using longstanding observational data from a rural Ugandan population and to identify factors associated with HIV transmission within couples, including the role of HSV-2 infection.MethodsUsing existing data collected at population-wide annual serological and behavioural surveys in a rural district in southwest Uganda between 1989 and 2007, HIV discordant partners were identified. Stored serum samples were tested for HSV-2 serostatus using the Kalon ELISA test. HIV seroconversion rates and factors association with HIV seroconversion were analysed using Poisson regression.ResultsHIV status of both partners was known in 2465 couples and of these 259 (10.5%) were HIV serodiscordant. At enrolment, HSV-2 prevalence was 87.3% in HIV positive partners and 71.5% in HIV negative partners. Of the 259 discordant couples, 62 converted to HIV (seroconversion rate 7.11/100 PYAR, 95%CI; 5.54, 9.11) with the rate decreasing from 10.89 in 1990–1994 to 4.32 in 2005–2007. Factors independently associated with HIV seroconversion were female sex, non-Muslim religion, greater age difference (man older than woman by more than 15 years), higher viral load in the positive partner and earlier calendar period. HSV-2 was not independently associated with HIV acquisition (HR 1.62, 95%CI; 0.57, 4.55) or transmission (HR 0.61, 95%CI; 0.24, 1.57). No transmissions occurred in the 29 couples where the index partner was on ART during follow up (872 person-years on ART).DiscussionHIV negative partners in serodiscordant couples have a high incidence of HIV if the index partner is not on antiretroviral therapy and should be provided with interventions such as couple counselling, condoms and antiretroviral treatment.
Highlights
Initiation of antiretroviral therapy reduces risk of transmission to the uninfected partner in HIV discordant couples, but there are relatively little observational data on HIV transmission within couples from non-trial settings
In generalised HIV epidemics in sub-Saharan Africa, a substantial proportion of new HIV infections occur in cohabiting couples [1]
The aims of this paper are i) to estimate HIV incidence among HIV discordant couples in this rural Ugandan population from 1989 to 2007; ii) to assess the role of HSV-2 infection on HIV transmission within couples and iii) to identify factors associated with HIV transmission within couples
Summary
Initiation of antiretroviral therapy reduces risk of transmission to the uninfected partner in HIV discordant couples, but there are relatively little observational data on HIV transmission within couples from non-trial settings. The aims of this paper are to estimate HIV incidence among HIV discordant couples using longstanding observational data from a rural Ugandan population and to identify factors associated with HIV transmission within couples, including the role of HSV2 infection. In Uganda, a modes of transmission study estimated that among adults aged 15 to 49 years, 43% of new HIV infections in 2008 occurred in monogamous relationships [4]. About 50% of married or cohabiting HIV positive individuals in stable partnerships in East and Southern Africa are in an HIVserodiscordant relationship [5]. Among married or cohabiting couples in the general population in rural Uganda, 5–7% were estimated to be HIV serodiscordant [6,7]. HIV transmission rates in serodiscordant partnerships are high, ranging from 3.7 to 19.0 per 100 person years at risk (PYAR) [1,6,8,9,10,11,12]
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