Discordant Couples Research Articles

High Initiation and Adherence among High Risk African HIV Discordant Couples in a Demonstration Project of PrEP and ART for HIV Prevention

High Initiation and Adherence among High Risk African HIV Discordant Couples in a Demonstration Project of PrEP and ART for HIV Prevention

Couples' Voluntary HIV Counseling and Testing (CVCT) Followed by Treatment as Prevention (TasP) for Discordant Couples: The Impact of Each Step

AIDS Research and Human RetrovirusesVol. 30, No. S1 Treatment as Prevention: Initiation, Adherence, and Monitoring on ARVCouples' Voluntary HIV Counseling and Testing (CVCT) Followed by Treatment as Prevention (TasP) for Discordant Couples: The Impact of Each StepSusan Allen, William Kilembe, Mubiana Inambao, Rachel Parker, Tyronza Sharkey, Naeemah Munir, Linda Kimaru, Sam Scherber, Kristin Wall, Amanda Tichacek, Bellington Vwalika, Eric Hunter, Joseph Mulenga, and Elwyn ChombaSusan AllenRwanda Zambia HIV Research Group-Emory University, Pathology & Laboratory Medicine, School of Medicine, Atlanta, GA, United StatesSearch for more papers by this author, William KilembeRwanda Zambia HIV Research Group, Zambia Emory HIV Research Project, Lusaka, ZambiaSearch for more papers by this author, Mubiana InambaoRwanda Zambia HIV Research Group, Zambia Emory HIV Research Project, Ndola, ZambiaSearch for more papers by this author, Rachel ParkerRwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, SOM, Emory University, Atlanta, GA, United StatesSearch for more papers by this author, Tyronza SharkeyRwanda Zambia HIV Research Group, Zambia Emory HIV Research Project, Lusaka, ZambiaSearch for more papers by this author, Naeemah MunirRwanda Zambia HIV Research Group, Zambia Emory HIV Research Project, Ndola, ZambiaSearch for more papers by this author, Linda KimaruRwanda Zambia HIV Research Group, Zambia Emory HIV Research Project, Ndola, ZambiaSearch for more papers by this author, Sam ScherberRwanda Zambia HIV Research Group, Zambia Emory HIV Research Project, Lusaka, ZambiaSearch for more papers by this author, Kristin WallEmory University School of Public Health, Epidemiology, Atlanta, GA, United StatesRwanda Zambia HIV Research Group, Lusaka, ZambiaSearch for more papers by this author, Amanda TichacekRwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, SOM, Emory University, Atlanta, GA, United StatesSearch for more papers by this author, Bellington VwalikaRwanda Zambia HIV Research Group, Zambia Emory HIV Research Project, Lusaka, ZambiaSearch for more papers by this author, Eric HunterEmory University School of Medicine, Department of Pathology & Laboratory Medicine, Atlanta, GA, United StatesSearch for more papers by this author, Joseph MulengaNational Blood Transfusion Services, Lusaka, ZambiaSearch for more papers by this author, and Elwyn ChombaMinistry of Community Medicine, Maternal & Child Health, Permanent Secretary, Lusaka, ZambiaSearch for more papers by this authorPublished Online:30 Oct 2014https://doi.org/10.1089/aid.2014.5646.abstractAboutSectionsView articleView Full TextPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Couples' Voluntary HIV Counseling and Testing (CVCT) Followed by Treatment as Prevention (TasP) for Discordant Couples: The Impact of Each Step." AIDS Research and Human Retroviruses, 30(S1), pp. A285–A286FiguresReferencesRelatedDetailsCited byRandomized evaluation and cost-effectiveness of HIV and sexual and reproductive health service referral and linkage models in Zambia12 August 2016 | BMC Public Health, Vol. 16, No. 1Engagement of Men in Antenatal Care Services: Increased HIV Testing and Treatment Uptake in a Community Participatory Action Program in Mozambique23 February 2016 | AIDS and Behavior, Vol. 20, No. 9Effect of Couples Counselling on Reported HIV Risk Behaviour among HIV Serodiscordant Couples by ART Use, HIV Status and Gender in Rural Uganda18 September 2015 | PLOS ONE, Vol. 10, No. 9 Volume 30Issue S1Oct 2014 InformationCopyright 2014, Mary Ann Liebert, Inc.To cite this article:Susan Allen, William Kilembe, Mubiana Inambao, Rachel Parker, Tyronza Sharkey, Naeemah Munir, Linda Kimaru, Sam Scherber, Kristin Wall, Amanda Tichacek, Bellington Vwalika, Eric Hunter, Joseph Mulenga, and Elwyn Chomba.Couples' Voluntary HIV Counseling and Testing (CVCT) Followed by Treatment as Prevention (TasP) for Discordant Couples: The Impact of Each Step.AIDS Research and Human Retroviruses.Oct 2014.A285-A286.http://doi.org/10.1089/aid.2014.5646.abstractPublished in Volume: 30 Issue S1: October 30, 2014PDF download

Characteristics of HIV Discordant Couples who Separated while Enrolled in a HIV Prevention Clinical Trial in Kenya

AIDS Research and Human RetrovirusesVol. 30, No. S1 PrEP Trials: Preparing for Demos, Participant ExperiencesCharacteristics of HIV Discordant Couples who Separated while Enrolled in a HIV Prevention Clinical Trial in KenyaLawrence Mwaniki Mwihaki, Elizabeth Mugoiri Irungu, John Njoroge Mwathi, Snaidah Ongachi Ayub, Kenneth Kairu Ngure, and Nelly Rwamba MugoLawrence Mwaniki MwihakiParters in Prevention Thika- University of Washington, Data, Nairobi, KenyaSearch for more papers by this author, Elizabeth Mugoiri IrunguParters in Prevention Thika- University of Washington, Clinic, Nairobi, KenyaSearch for more papers by this author, John Njoroge MwathiParters in Prevention Thika- University of Washington, Counseling, Nairobi, KenyaSearch for more papers by this author, Snaidah Ongachi AyubParters in Prevention Thika- University of Washington, Counseling, Nairobi, KenyaSearch for more papers by this author, Kenneth Kairu NgureParters in Prevention Thika- University of Washington, Managerial, Nairobi, KenyaSearch for more papers by this author, and Nelly Rwamba MugoParters in Prevention Thika- University of Washington, Managerial, Nairobi, KenyaSearch for more papers by this authorPublished Online:30 Oct 2014https://doi.org/10.1089/aid.2014.5607.abstractAboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Characteristics of HIV Discordant Couples who Separated while Enrolled in a HIV Prevention Clinical Trial in Kenya." AIDS Research and Human Retroviruses, 30(S1), p. A270FiguresReferencesRelatedDetails Volume 30Issue S1Oct 2014 InformationCopyright 2014, Mary Ann Liebert, Inc.To cite this article:Lawrence Mwaniki Mwihaki, Elizabeth Mugoiri Irungu, John Njoroge Mwathi, Snaidah Ongachi Ayub, Kenneth Kairu Ngure, and Nelly Rwamba Mugo.Characteristics of HIV Discordant Couples who Separated while Enrolled in a HIV Prevention Clinical Trial in Kenya.AIDS Research and Human Retroviruses.Oct 2014.A270-A270.http://doi.org/10.1089/aid.2014.5607.abstractPublished in Volume: 30 Issue S1: October 30, 2014PDF download

Prevalence and Determinants of Hepatitis B Virus (HBV) Infection in a Cohort of HIV-1 Discordant Couples in Western Kenya: Implications for HIV Care

AIDS Research and Human RetrovirusesVol. 30, No. S1 Sexually Transmitted InfectionsPrevalence and Determinants of Hepatitis B Virus (HBV) Infection in a Cohort of HIV-1 Discordant Couples in Western Kenya: Implications for HIV CareDismas C.O. Oketch, Eunice Kaguiri, Nereo Murgor, Cosmas Apaka, Paul Ayuo, Edwin Were, and Kenneth FifeDismas C.O. OketchMoi University School of Medicine, Partners in Prevention, Eldoret, KenyaSearch for more papers by this author, Eunice KaguiriMoi University School of Medicine, Partners in Prevention, Eldoret, KenyaSearch for more papers by this author, Nereo MurgorMoi University School of Nursing, Eldoret, KenyaSearch for more papers by this author, Cosmas ApakaMoi University College of Health Sciences, Center of Excellence for Cardiovascular & Respiratory Diseases, Eldoret, KenyaSearch for more papers by this author, Paul AyuoMoi University School of Medicine, Department of Internal Medicine, Eldoret, KenyaSearch for more papers by this author, Edwin WereMoi University School of Medicine, Department of Reproductive Health, Eldoret, KenyaSearch for more papers by this author, and Kenneth FifeIndiana University School of Medicine, Department of Medicine & Infectious Diseases, Indianapolis, IN, United StatesSearch for more papers by this authorPublished Online:30 Oct 2014https://doi.org/10.1089/aid.2014.5632.abstractAboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Prevalence and Determinants of Hepatitis B Virus (HBV) Infection in a Cohort of HIV-1 Discordant Couples in Western Kenya: Implications for HIV Care." AIDS Research and Human Retroviruses, 30(S1), p. A280FiguresReferencesRelatedDetails Volume 30Issue S1Oct 2014 InformationCopyright 2014, Mary Ann Liebert, Inc.To cite this article:Dismas C.O. Oketch, Eunice Kaguiri, Nereo Murgor, Cosmas Apaka, Paul Ayuo, Edwin Were, and Kenneth Fife.Prevalence and Determinants of Hepatitis B Virus (HBV) Infection in a Cohort of HIV-1 Discordant Couples in Western Kenya: Implications for HIV Care.AIDS Research and Human Retroviruses.Oct 2014.A280-A280.http://doi.org/10.1089/aid.2014.5632.abstractPublished in Volume: 30 Issue S1: October 30, 2014PDF download

Are you HIV invincible? A probabilistic study of discordant couples in the context of HIV transmission.

A number of factors have been identified that are related to sexual and injecting HIV transmission. We developed a probabilistic mathematical model to put these factors together and interpret risks in the context of individual behavior among injecting drug-using (IDU) couples in St. Petersburg, Russia. Some HIV-discordant couples have unprotected sex and sometimes inject drugs together but stay discordant for a long time, while some individuals acquire HIV on the first encounter. We considered existing estimates of HIV transmission risks through injecting and sexual contacts to develop a predictive survival model for an individual who is exposed to HIV through intimate relationships. We computed simulated survival curves for a number of behavioral scenarios and discussed sources of simulated uncertainty. We then applied the model to a longitudinal study of HIV-discordant couples and validated the model’s forecast. Although individual prediction of seroconversion time appeared impossible, the ability to rank behavioral patterns in terms of HIV risk and to estimate the probability of survival HIV-free will be important to educators and counselors.

Variations in KIR genes: a study in HIV-1 serodiscordant couples.

Background. NK cells have anti-HIV activity mediated through killer cell immunoglobulin-like receptors (KIRs). The current prospective cohort study evaluated whether variation in KIR genes is associated with HIV infection in discordant couples (DCs), where one spouse remains seronegative (HSN) despite repeated exposure to the HIV. Methods. KIR was genotyped using PCR SSP. Viral load and CD4 counts were estimated using commercially available reagents. Data were analyzed using SPSS software. Results. Among the 47 DCs, HSN spouses had significantly (P = 0.006) higher frequencies of KIR3DS1. Regression analysis revealed significant (P = 0.009) association of KIR2DS1 with low viral load. KIR2DS4 variant was associated (P = 0.032) with high viral load. Three pairs of KIR genes were in strong LD in HSNs and two pairs in HSPs. There were 60 KIR genotypes, and 16 are reported the first time in the Indian population. Exclusive genotypes were present either in HSPs (N = 22, 11 unique genotypes) or in HSNs (n = 27, 9 unique genotypes). Conclusions. This study highlights for the first time in the Indian population an association of KIR genes in HIV infection where presence of exclusive and unique genotypes indicates possible association with either HIV infection or with protection.

HIV Sexual Transmission Is Predominantly Driven by Single Individuals Rather than Discordant Couples: A Model-Based Approach

Understanding the relative contribution to HIV transmission from different social groups is important for public-health policy. Information about the importance of stable serodiscordant couples (when one partner is infected but not the other) relative to contacts outside of stable partnerships in spreading disease can aid in designing and targeting interventions. However, the overall importance of within-couple transmission, and the determinants and correlates of this importance, are not well understood. Here, we explore how mechanistic factors – like partnership dynamics and rates of extra-couple transmission – affect various routes of transmission, using a compartmental model with parameters based on estimates from Sub-Saharan Africa. Under our assumptions, when sampling model parameters within a realistic range, we find that infection of uncoupled individuals is usually the predominant route (median 0.62, 2.5%–97.5% quantiles: 0.26–0.88), while transmission within discordant couples is usually important, but rarely represents the majority of transmissions (median 0.33, 2.5%–97.5% quantiles: 0.10–0.67). We find a strong correlation between long-term HIV prevalence and the contact rate of uncoupled individuals, implying that this rate may be a key driver of HIV prevalence. For a given level of prevalence, we find a negative correlation between the proportion of discordant couples and the within-couple transmission rate, indicating that low discordance in a population may reflect a relatively high rate of within-couple transmission. Transmission within or outside couples and among uncoupled individuals are all likely to be important in sustaining heterosexual HIV transmission in Sub-Saharan Africa. Hence, intervention policies should be broadly targeted when practical.

Antiretroviral Therapy Reduces HIV Transmission in Discordant Couples in Rural Yunnan, China

BackgroundAlthough HIV treatment as prevention (TasP) via early antiretroviral therapy (ART) has proven to reduce transmissions among HIV-serodiscordant couples, its full implementation in developing countries remains a challenge. In this study, we determine whether China's current HIV treatment program prevents new HIV infections among discordant couples in rural China.MethodsA prospective, longitudinal cohort study was conducted from June 2009 to March 2011, in rural Yunnan. A total of 1,618 HIV-discordant couples were eligible, 1,101 were enrolled, and 813 were followed for an average of 1.4 person-years (PY). Routine ART was prescribed to HIV-positive spouses according to eligibility (CD4<350 cells/µl). Seroconversion was used to determine HIV incidence.ResultsA total of 17 seroconversions were documented within 1,127 PY of follow-up, for an overall incidence of 1.5 per 100 PY. Epidemiological and genetic evidence confirmed that all 17 seroconverters were infected via marital secondary sexual transmission. Having an ART-experienced HIV-positive partner was associated with a lower rate of seroconvertion compared with having an ART-naïve HIV-positive partner (0.8 per 100 PY vs. 2.4 per 100 PY, HR = 0.34, 95%CI = 0.12–0.97, p = 0.0436). While we found that ART successfully suppressed plasma viral load to <400 copies/ml in the majority of cases (85.0% vs. 19.5%, p<0.0001 at baseline), we did document five seroconversions among ART-experienced subgroup.ConclusionsART is associated with a 66% reduction in HIV incidence among discordant couples in our sample, demonstrating the effectiveness of China's HIV treatment program at preventing new infections, and providing support for earlier ART initiation and TasP implementation in this region.

Past Present: Discordant Gay Male Couples, HIV Infection History, and Relationship Dynamics

Discordant couples are unique because partners do not share the same serostatus. Yet research overlooks how they became discordant, mistakenly assuming that they have always been that way and, by extension, that being discordant impacts the relationship in a similar manner. This study examines HIV infection history and its impact on relationship dynamics using qualitative data from 35 discordant gay male couples. Most couples were discordant when they met (69%); however, many were not (31%). Those couples that met discordant felt being discordant had a lesser impact on their sexual and relational satisfaction, while those that did not meet discordant felt it had a greater impact, reporting sexual frustration and anxiety over seroconverting. This suggests that relationship dynamics may differ for discordant couples depending on HIV infection history. HIV prevention and counseling services for discordant couples can be better tailored and more effective when differences in HIV infection history are recognized.

P3.265 Discordant Couples in HIV/AIDS Cycle

ObjectivesA large proportion of new HIV infections in sub-Saharan Africa occur in stable HIV-discordant partnerships. In some couples, the strong desire to conceive a child may lead to risky behaviour...

P4.126 Availability of Services For Discordant Couples to Prevent HIV and STIs

IntroductionA survey was conducted in the three regions of Russia, Orel, Bryansk and Voronezh from 2008 to 2012. 64 HIV-negative partners living more than a year in a HIV discordant-couple...

Enhancing Acceptability and Use of Sexual Barrier Products Among HIV Concordant and Discordant Couples

Strategies to prevent HIV transmission may benefit from addressing both individual and dyadic factors. This study compared the impact of group and individual interventions on the acceptability of sexual barrier products among HIV sero-concordant and discordant couples, and evaluated the contribution of couple members' perceived product acceptability to their sexual barrier use. Participants (n = 216 couples) were multicultural couples in Miami, Florida. Longitudinal multilevel modeling and the actor-partner interdependence model were used for analyses. Product acceptability increased more among female group participants, and acceptability of male condoms increased more among sero-discordant couples in the group. Additionally, acceptability of products associated with prevention of STDS/HIV and pregnancy increased more among sero-concordant couples in the group condition. Both actor and partner product acceptability predicted use. Results support the use of group interventions targeting both partners in relationships in prevention programs designed to enhance sexual barrier use.

Ethical Dilemma and Management of Infertility in HIV Seropositive Discordant Couples: A Case Study in Nigeria

The traditional African society places an invaluable premium on procreation and, in some communities, a woman's place in her matrimony is only confirmed on positive reproductive outcome. Infertility is rife in Nigeria, and HIV/acquired immunodeficiency syndrome (AIDS) infection is a global pandemic, which has led to a drop in life expectancy across the world. In Nigeria, a number of cultural norms relating to gender roles and power dynamics constitute a serious barrier to issues of sexuality and infertility. Couples are concerned about their infertility diagnostic test being disclosed to each other, especially before marriage. This concern is understandable, especially in an environment that lacks the modern concepts and attitude toward sexual matters. This is complicated by the advent of HIV/AIDS infection and the societal mind-set that look at seropostive individuals as transgressors. At present, sexual and reproductive health rights are currently not in place because ethical issues are not given prominence by many physicians in Nigeria. A case of an infertile and seropostive discordant couple, which raised a lot of medical and ethical concerns, is presented here to awaken the consciousness of Nigerian physicians and stimulate discussions on the ethical matters such as this in clinical practice.

Pregnant women and disclosure to sexual partners after testing HIV-1-seropositive during antenatal care.

In African countries highly affected by human immunodeficiency virus-1 (HIV-1) women are more likely to be tested for HIV-1 than men due to scale-up of antenatal testing programs to prevent mother-to-child transmission (PMTCT) of HIV-1. As part of standard post-test counseling HIV-1 seropositive women are advices to disclose their status to their partners and refer them for testing. Disclosure to male partners antenatally has been associated with improved adherence to prevention of PMTCT regimens better infant feeding practices safer sex practices and increase male partner testing. Despite these findings promotion of male partner disclosure is not a central component of most PMTCT programs. While barriers to female-to-male disclosure are well-described and include socio-economic vulnerability fear of violence of abandonment and family stigma little has been published describing how to promote disclosure to male partners after antenatal testing. This study followed Kenyan HIV-1 – seropositive women enrolled in a randomized clinical trial of herpes suppression during pregnancy until 1 year postpartum to determine disclosure rates and to assess timing and correlates of disclosure. Our hypothesis was that women who were counseled and supported to disclose their HIV-1 status as part of a longitudinal research study would over time be more likely to disclose to partners. There is clear evidence that promoting disclosure to partners in the antenatal setting can lead to both individual and public health benefits but little is known about how to achieve this goal. The research indicates that rather than focusing on strategies that focus on strategies that promote disclosure by women such as counseling there should be an emphasis on strategies that make HIV-1 testing more appealing to men in this setting such as shifts in infrastructure promoting ease and availability of testing and reduction of stigma and barriers to male partner HIV-1 testing and treatment. In conclusion the research shows that mothers diagnosed with HIV-1 antenatally face challenges in disclosing to their male partners.

O462 A CASE FOR VAGINAL INSEMINATION AS A SAFER METHOD OF CONCEPTION IN HIV DISCORDANT COUPLES (FEMALE POSITIVE, MALE NEGATIVE) DESIRING CONCEPTION IN KISUMU, KENYA

International Journal of Gynecology & ObstetricsVolume 119, Issue S3 p. S425-S425 Free communication (oral) presentations O462 A CASE FOR VAGINAL INSEMINATION AS A SAFER METHOD OF CONCEPTION IN HIV DISCORDANT COUPLES (FEMALE POSITIVE, MALE NEGATIVE) DESIRING CONCEPTION IN KISUMU, KENYA O. Mmeje, O. MmejeSearch for more papers by this authorB. Njoroge, B. NjorogeSearch for more papers by this authorE.A. Bukusi, E.A. BukusiSearch for more papers by this authorC.R. Cohen, C.R. CohenSearch for more papers by this author O. Mmeje, O. MmejeSearch for more papers by this authorB. Njoroge, B. NjorogeSearch for more papers by this authorE.A. Bukusi, E.A. BukusiSearch for more papers by this authorC.R. Cohen, C.R. CohenSearch for more papers by this author First published: 22 October 2012 https://doi.org/10.1016/S0020-7292(12)60892-3AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume119, IssueS3Abstracts of XX FIGO World Congress of Gynecology and ObstetricsOctober 2012Pages S425-S425 RelatedInformation

Prevalence of Inconsistent Condom Use and Associated Factors Among HIV Discordant Couples in a Rural County in China

A random sample consisting of 88 sexually active people living with HIV (PLWH) and their HIV negative spouses in rural China were interviewed. Data of 68 couples (77.2 %) who gave identical responses to whether they had been using condoms consistently in the last 12 months (n = 136) were analyzed. The results showed that 27.9 % of the discordant couples used condom inconsistently in the last year. Condom non-availability was the most commonly given main reason for not using condoms. Free condoms should be made available to these low-income couples. Suicidal ideation of the PLWH and the spouse's perception on 'whether someone could contract HIV via unprotected sexual intercourse with a HIV positive person' were significantly associated with inconsistent condom use in the last year. Education program should change the cognition about the risk for HIV transmission via unprotected sex. Integrated psychological services to reduce suicidal ideation are greatly warranted.

459 Peculiarities of HIV-specific Immune Response in Discordant Couples

BackgroundIn HIV discordant couples (one parther is HIV-infected, another is HIV-uninfected) HIV-negative partners often remain uninfected for a long time despite long, stable, often unprotected sexual contacts with HIV-infected partner. The increase of time of living together accompanying the decrease of the incidence of HIV infection in HIV-negative partner. The features of HIV-specific immune response in HIV discorgant couples was investigated.MethodsThirty-three HIV discordant couples from Moscow region living together <1 year (2 couples), 1 to 3 years (18 couples), 4 to 5 years (9 couples), 6 to 10 years (4 couples) were included in the investigation. Sera of 33 HIV-uninfected partners from HIV discordant couples (17 men and 16 women) were tested for HIV-specific antibodies by enzyme immunoassay and immunoblot. Viral load was estimated by polymerase chain reaction (PCR).ResultsAntibodies against HIV gp160 were detected in 3 persons (9,1%), against p68/66—in 3 persons (9,1%), against p52/51—in 3 persons (9,1%), against g34/31—in 3 persons (9,1%); total—in 6 persons (18,2%). All of them were defined as HIV-uninfected by PCR. In 4 of 6 persons HIV-specific antibodies were not detected after finishing of risk behavior.ConclusionsIt is possible to suggest that detected antibodies against HIV gp160, p68/66, p52/51, p34/31 in HIV-uninfected people are caused by contact with HIV (according to literature data, non-specific stimulation may cause the appearance of antibodies binding the other HIV antigens: p55, p24/25 and g18) and may contribute to maintainance of HIV-negative status of uninfected partners in HIV-discordant couples. The cohort of high exposed but HIV-uninfected people was formed during immunological monitoring of HIV discordant couples in Moscow region. This cohort is available for systematic observation and is perspective for further investigation of mechanisms of resistance to HIV infection and correlates of immune protection. Now the cohort is expanded.

HIV Incidence and Risk Factors for Acquisition in HIV Discordant Couples in Masaka, Uganda: An HIV Vaccine Preparedness Study

ObjectivesTo determine the incidence of and risk factors for HIV acquisition in a cohort of HIV-uninfected partners from HIV discordant couples in Masaka, Uganda, and to establish its suitability for HIV vaccine trials.MethodsHIV-uninfected adults living in HIV discordant couple relationships were enrolled and followed for 2 years. Interviews, medical investigations, HIV counseling and testing, syphilis and urine pregnancy (women) tests were performed at quarterly visits. Sexual risk behaviour data were collected every 6 months.Results495 participants were enrolled, of whom 34 seroconverted during 786.6 person-years of observation (PYO). The overall HIV incidence rate [95% confidence interval (CI)] was 4.3 [3.1–6]; and 4.3 [2.8–6.4] and 4.4 [2.5–8] per 100 PYO in men and women respectively. Independent baseline predictors for HIV acquisition were young age [18–24 (aRR = 4.1, 95% CI 1.6–10.8) and 25–34 (aRR = 2.7, 95% CI 1.2–5.8) years]; alcohol use (aRR = 2.6, 95% CI 1.1–6); and reported genital discharge (aRR = 3.4, 95% CI 1.6–7.2) in the past year. Condom use frequency in the year preceding enrolment was predictive of a reduced risk of HIV acquisition [sometimes (aRR = 0.4, 95% CI 0.2–0.8); always (aRR = 0.1, 95% CI 0.02–0.9)]. In the follow-up risk analysis, young age [18–24 (aRR = 6.2, 95% CI 2.2–17.3) and 25-34 (aRR = 2.3, 95% CI 1.1–5.0) years], reported genital discharge (aRR = 2.5, 95% CI 1.1–5.5), serological syphilis (aRR 3.2, 95% CI 1.3–7.7) and the partner being ART naïve (aRR = 4.8, 95% CI 1.4–16.0) were independently associated with HIV acquisition. There were no seroconversions among participants who reported consistent condom use during the study.ConclusionsThe study has identified important risk factors for HIV acquisition among HIV discordant couples. HIV-uninfected partners in discordant couples may be a suitable population for HIV vaccine efficacy trials. However, recent confirmation that ART reduces heterosexual HIV transmission may make it unfeasible to conduct HIV prevention trials in this population.

P1-S5.04 HSV-2 Prevalence and Incidence among Stable HIV-1 Discordant Couples in Nairobi, Kenya

BackgroundTo describe HSV-2 prevalence, incidence and their correlates among stable HIV-1 discordant heterosexual couples enrolled in an HIV-1 prevention cohort study in Nairobi, Kenya.MethodsBetween 2007 and 2009, 469 HIV-1 discordant...

Impact of a Functional KIR2DS4 Allele on Heterosexual HIV-1 Transmission among Discordant Zambian Couples

Killer cell immunoglobulin-like receptors (KIRs) and their HLA ligands interact to regulate natural killer (NK) cell function. KIR gene content and allelic variations are reported to influence human immunodeficiency virus (HIV)-1 infection and pathogenesis. We investigated the impact of KIR genes on heterosexual HIV-1 transmission among 566 discordant couples from Lusaka, Zambia. KIR2DS4*001, the only allele of KIR2DS4 known to encode a functional activating receptor, was associated with relatively high viral load for HIV-1 in index (HIV-1 seroprevalent) partners (β [standard error (SE)], .17 [.8] log₁₀; P = .04) and with accelerated transmission of HIV-1 to cohabiting seronegative partners (relative hazard [RH], 2.00; P = .004). The latter association was independent of the direction of transmission (male-to-female or female-to-male), genital ulcers, and carriage of the putative ligand (HLA-Cw*04). No KIR-gene variant in the initially seronegative partners was associated with HIV-1 acquisition or early viral load following seroconversion. Further analysis of NK cell function should clarify the role of KIR2DS4*001 in HIV-1 transmission.