HIV seroconversion and prevalence rates in heterosexual discordant couples in China: A systematic review and meta-analysis

Abstract

This study aims to systematically review published literature on heterosexual transmission among HIV discordant couples in China. We conducted a systematic review and random-effects meta-analysis of 32 published articles in both Chinese and English. The summarized overall HIV seroconversion rate among discordant couples in China is 1.2 per 100 person-years (95% CI 0.9–1.7/100 PY). The overall estimate for HIV prevalence through heterosexual transmission in discordant couples is 11.5% (95% CI 8.2%–15.2%) in China. In a stratified meta-analysis by region, Henan province showed an HIV seroconversion rate of 0.9/100 PY (95% CI 0.6–1.2/100 PY) and an HIV prevalence rate of 3.9% (95% CI 2.5–5.7%). Yunnan province showed an HIV seroconversion rate of 1.7/100 PY (95% CI 1.2–2.3/100 PY) and an HIV prevalence rate of 17.0% (95% CI 13.7–20.6%). Other provinces collectively showed a HIV seroconversion rate of 3.9/100 PY (95% CI 1.0–8.7/100 PY) and an HIV prevalence rate of 21.5% (95% CI 9.6–36.5%). In a stratified meta-analysis by time, the subgroup from 1994 to 2004 had a seroconversion rate of 3.9/100 PY (95% CI 1.0–8.7/100 PY) and the subgroup from 2005 to 2011 had a seroconversion rate of 1.1/100 PY (95% CI 0.8–1.5/100 PY). These data show that China's free national HIV prevention and treatment program has been successful at limiting transmission in discordant couples. Because heterosexual transmission is now the dominant method of HIV transmission in China, it is important to understand seroconversion and prevalence rates in discordant couples to develop more effective prevention and treatment programs.