Abstract
BackgroundA large number of HIV-1 infections in Africa occur in married couples. The predominant direction of intracouple transmission and the principal external origins of infection remain important issues of debate.MethodsWe investigated HIV-1 transmission in 46 HIV-1 concordant positive couples from Dakar, Senegal. Intracouple transmission was confirmed by maximum-likelihood phylogenetic analysis and pairwise distance comparisons of HIV-1 env gp41 sequences from both partners. Standardized interview data were used to deduce the direction as well as the external sources of the intracouple transmissions.ResultsConservative molecular analyses showed linked viruses in 34 (74%) couples, unlinked viruses in 6 (13%) couples, and indeterminate results for 6 (13%) couples. The interview data corresponded completely with the molecular analyses: all linked couples reported internal transmission and all unlinked couples reported external sources of infection. The majority of linked couples (93%) reported the husband as internal source of infection. These husbands most frequently (82%) reported an occasional sexual relationship as external source of infection. Pairwise comparisons of the CD4 count, antiretroviral therapy status, and the proportion of gp41 ambiguous base pairs within transmission pairs correlated with the reported order of infection events.ConclusionsIn this suburban Senegalese population, a majority of HIV-1 concordant couples showed linked HIV-1 transmission with the husband as likely index partner. Our data emphasize the risk of married women for acquiring HIV-1 as a result of the occasional sexual relationships of their husbands.
Highlights
The HIV-1 epidemic in Sub-Saharan Africa is mainly driven by heterosexual transmission [1,2]
It was estimated that the majority of HIV-1 infections in Africa occur within married couples, with comparable frequencies of male-to-female and female-to-male transmissions [11]
We found that a majority of HIV-1 concordant couples harbored linked HIV-1 sequences with the husband as the likely index partner in these couples
Summary
The HIV-1 epidemic in Sub-Saharan Africa is mainly driven by heterosexual transmission [1,2]. Many individuals in stable relationships are infected [3], which has led to a growing interest in understanding the dynamics and risk factors of within-couple HIV-1 transmissions. Meta-analysis studies observed large proportions of HIV-1 discordant couples in African countries [9], with women as likely as men to be the HIV-1 positive partner in these couples [10]. Based on these data, it was estimated that the majority of HIV-1 infections in Africa occur within married couples, with comparable frequencies of male-to-female and female-to-male transmissions [11]. The predominant direction of intracouple transmission and the principal external origins of infection remain important issues of debate
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