Index Partner Research Articles

Antiretroviral therapy to prevent HIV transmission in serodiscordant couples in China (2003–11): a national observational cohort study

On the basis of the results of the randomised clinical trial HPTN 052 and observational studies, WHO has recommended that antiretroviral therapy be offered to all HIV-infected individuals with uninfected partners of the opposite sex (serodiscordant couples) to reduce the risk of transmission. Whether or not such a public health approach is feasible and the outcomes are sustainable at a large scale and in a developing country setting has not previously been assessed. In this retrospective observational cohort study, we included treated and treatment-naive HIV-positive individuals with HIV-negative partners of the opposite sex who had been added to the national HIV epidemiology and treatment databases between Jan 1, 2003 and Dec 31, 2011. We analysed the annual rate of HIV infection in HIV-negative partners during follow-up, stratified by treatment status of the index partner. Cox proportional hazards analyses were done to examine factors related to HIV transmission. Based on data from 38,862 serodiscordant couples, with 101,295·1 person-years of follow-up for the seronegative partners, rates of HIV infection were 2·6 per 100 person-years (95% CI 2·4-2·8) among the 14,805 couples in the treatment-naive cohort (median baseline CD4 count for HIV-positive partners 441 cells per μl [IQR 314-590]) and 1·3 per 100 person-years (1·2-1·3) among the 24,057 couples in the treated cohort (median baseline CD4 count for HIV-positive partners 168 cells per μl [62-269]). We calculated a 26% relative reduction in HIV transmission (adjusted hazard ratio 0·74, 95% CI 0·65-0·84) in the treated cohort. The reduction in transmission was seen across almost all demographic subgroups and was significant in the first year (0·64, 0·54-0·76), and among couples in which the HIV-positive partner had been infected by blood or plasma transfusion (0·76, 0·59-0·99) or heterosexual intercourse (0·69, 0·56-0·84), but not among couples in which the HIV-positive partner was infected by injecting drugs (0·98, 0·71-1·36). Antiretroviral therapy for HIV-positive individuals in serodiscordant couples reduced HIV transmission across China, which suggests that the treatment-as-prevention approach is a feasible public health prevention strategy on a national scale in a developing country context. The durability and generalisability of such protection, however, needs to be further studied. Chinese Government's 12th Five-Year Plan, the National Natural Science Foundation of China, and the Canadian International Development Research Centre.

Association between herpes simplex virus type 2 and HIV-1 in a population of married couples from Dakar, Senegal

Numerous studies suggest that herpes simplex virus type 2 (HSV-2) increases the risk of HIV-1 infection but recent clinical trials of HSV-2 suppressive therapy failed to show an effect. We assessed the putative association between HSV-2 and HIV-1 in a population of HIV-concordant-negative, HIV-1-discordant and HIV-1-concordant-positive married couples from Dakar, Senegal. In agreement with previous studies, we observed a strong overall association between HSV-2 and HIV-1 (odds ratio 4.61; P < 0.001). However, this association was mainly determined by a low HSV-2 prevalence in HIV-concordant-negative couples compared with HIV-1-discordant and HIV-1-concordant-positive couples (23% versus 59% and 66%, respectively; P < 0.001). We observed no further differences in HSV-2 prevalence between HIV-1-discordant and HIV-1-concordant-positive couples (59% and 66%, respectively; P = 0.483). Neither the index (59% versus 62%, P = 1.000) nor recipient partners (41% versus 63%, P = 0.131) in HIV-1-discordant and HIV-1-concordant-positive couples showed significant differences in HSV-2 prevalence. HSV-2 does not constitute a clear risk factor for HIV-1 infection in this population.

HIV disease progression compared by linkage status in Rwanda and Zambia

Background Recently HIV infected individuals are followed up at Rwanda-Zambia HIV Research Group (RZHRG) sites to establish markers of disease progression. Here we compare disease progression between seroconverters infected by their spouses (linked transmission) to those infected by non-spousal partners (unlinked transmission) where a greater fraction of individuals are infected by multiple virus variants. Methods Seroconverters (SC) were identified from HIV discordant couples enrolled from the Couples’ VCT program into a prospective cohort study. Linkage of transmission was established by comparing viral DNA sequences in the SC to that of the suspected index partner. SCs were followed up to six years to collect clinical and laboratory data. Data analysis using STATA was done on CD4 and viral load trajectories and a comparison of disease progression with respect to time to endpoints of CD4 <350 cells/uL and initiation of ARVs. Log rank test of equality for survival function was performed for each endpoint and p-values calculated.

Partners of people on ART - a New Evaluation of the Risks (The PARTNER study): design and methods

BackgroundIt is known that being on antiretroviral therapy reduces the risk of HIV transmission through sex. However it remains unknown what the absolute level of risk of transmission is in a person on ART with most recent measured HIV plasma viral load<50 c/mL in the absence of condom use. There are no data on risk of transmission for anal sex in MSM when the index partner is on ART.Methods/DesignThe PARTNER study is an international, observational multi-centre study, taking place from 2010 to 2014 in which HIV serodifferent partnerships who at enrolment reported recently having had condom-less vaginal or anal sexual intercourse are followed over time, with 46 monthly reporting of transmission risk behaviour through a confidential self completed risk behaviour questionnaire and with 46 monthly HIV testing for the HIV negative partner. The objective is to study (i) the risk of HIV transmission to partners, in particular in partnerships that continue not to use condoms consistently and the HIV-positive partner is on therapy with a viral load<50 copies/mL and (ii) why some partnerships do not use condoms, to describe the proportion who begin to adopt consistent condom use, and factors associated with this. For any negative partner who becomes infected phylogenetic analysis will be used following anonymisation of the samples to assess if transmission had been from the HIV infected partner.DiscussionThis observational study will provide missing information on the absolute risk of HIV transmission for both vaginal and anal sex when the index case is on ART with a VL<50 copies/mL in the absence of condom use.

Molecular Epidemiology of HIV-1 Transmission in a Cohort of HIV-1 Concordant Heterosexual Couples from Dakar, Senegal

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.

Disparate Associations of HLA Class I Markers with HIV-1 Acquisition and Control of Viremia in an African Population

BackgroundAcquisition of human immunodeficiency virus type 1 (HIV-1) infection is mediated by a combination of characteristics of the infectious and the susceptible member of a transmission pair, including human behavioral and genetic factors, as well as viral fitness and tropism. Here we report on the impact of established and potential new HLA class I determinants of heterosexual HIV-1 acquisition in the HIV-1-exposed seronegative (HESN) partners of serodiscordant Zambian couples.Methodology/Principal FindingsWe assessed the relationships of behavioral and clinically documented risk factors, index partner viral load, and host genetic markers to HIV-1 transmission among 568 cohabiting couples followed for at least nine months. We genotyped subjects for three classical HLA class I genes known to influence immune control of HIV-1 infection. From 1995 to December 2006, 240 HESNs seroconverted and 328 remained seronegative. In Cox proportional hazards models, HLA-A*68:02 and the B*42-C*17 haplotype in HESN partners were significantly and independently associated with faster HIV-1 acquisition (relative hazards = 1.57 and 1.55; p = 0.007 and 0.013, respectively) after controlling for other previously established contributing factors in the index partner (viral load and specific class I alleles), in the HESN partner (age, gender), or in the couple (behavioral and clinical risk score). Few if any previously implicated class I markers were associated here with the rate of acquiring infection.Conclusions/SignificanceA few HLA class I markers showed modest effects on acquisition of HIV-1 subtype C infection in HESN partners of discordant Zambian couples. However, the striking disparity between those few markers and the more numerous, different markers found to determine HIV-1 disease course makes it highly unlikely that, whatever the influence of class I variation on the rate of infection, the mechanism mediating that phenomenon is identical to that involved in disease control.

S12.1 Transmission of human papillomavirus infections

BackgroundThere have been few studies of the sexual transmission of human papillomavirus (HPV) between partners. Our objective was to estimate transmission rates among persons with documented sexual exposure to an...

The contribution of HIV-discordant relationships to new HIV infections: a rebuttal

This letter responds to the previous letter about HIV discordant couples and their role in the HIV epidemic. The authors here state that the HIV discordant couples have been misclassified. Instead the HIV couples should be regarded as couples who voluntarily sought out counseling and testing. These couples indicate high interest in condition disclosure and counseling. This population does not include individuals who resisted testing disclosure or counseling. Thus this report cannot and does not attempt to discuss HIV-discordant couples who refrain from being identified.

Perceived Ejaculate Volume Reduction in Patients With Erectile Dysfunction: Psychobiologic Correlates

The disorders of orgasm/ejaculation encompass a heterogeneous group of dysfunctions including premature ejaculation, delayed ejaculation, and perceived ejaculate volume reduction (PEVR). The aim of this study was to explore specific associations of PEVR in a consecutive series of 3141 patients (mean age, 51.6 ± 13.1 years) seeking consultation for erectile dysfunction (ED). Among these, 71 were excluded because they underwent prostate surgery. Different clinical and biochemical factors were evaluated along with parameters derived from the Structured Interview on Erectile Dysfunction evaluating the contribution of organic, relational, and intrapsychic factors to ED. After adjustment for confounders, PEVR was specifically associated with the use of androgen deprivation therapy as well as with different other medications including α-blockers, serotonergic reuptake inhibitor antidepressants, and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers. A higher prevalence of diabetes mellitus and hypogonadism was observed in patients with PEVR compared with the rest of the sample (23.0% vs 14.1% and 9.1% vs 5.3% respectively; both P < .05). In addition, different sexual parameters such as severe ED (hazard ratio [HR] = 1.25 [1.11-1.41]; P < .0001) and patient's (HR = 1.53 [1.38-1.70]; P < .0001) and partner's (HR = 1.21 [1.07-1.36]; P < .005) hypoactive sexual desire (HSD) were also significantly related to PEVR. Furthermore, PEVR was associated with an impairment of both the relational and intrapsychic components of ED. In a multivariate model, adjusting for age, body mass index, smoking habits, and medications, hypogonadism, diabetes mellitus, severe ED, and patient's and partner's HSD were all independently associated with PEVR. Our results indicate that PEVR is important not only for couple reproductive purposes but also appears to have a distinct role in the couple's sexual performance.

Association of chemokine receptor gene (CCR2-CCR5) haplotypes with acquisition and control of HIV-1 infection in Zambians

BackgroundPolymorphisms in chemokine (C-C motif) receptors 2 and 5 genes (CCR2 and CCR5) have been associated with HIV-1 infection and disease progression. We investigated the impact of CCR2-CCR5 haplotypes on HIV-1 viral load (VL) and heterosexual transmission in an African cohort. Between 1995 and 2006, cohabiting Zambian couples discordant for HIV-1 (index seropositive and HIV-1 exposed seronegative {HESN}) were monitored prospectively to determine the role of host genetic factors in HIV-1 control and heterosexual transmission. Genotyping for eight CCR2 and CCR5 variants resolved nine previously recognized haplotypes. By regression and survival analytic techniques, controlling for non-genetic factors, we estimated the effects of these haplotypic variants on a) index partner VL, b) seroconverter VL, c) HIV-1 transmission by index partners, d) HIV-1 acquisition by HESN partners.ResultsAmong 567 couples, 240 virologically linked transmission events had occurred through 2006. HHF*2 homozygosity was associated with significantly lower VL in seroconverters (mean beta = -0.58, log10 P = 0.027) and the HHD/HHE diplotype was associated with significantly higher VL in the seroconverters (mean beta = 0.54, log10 P = 0.014) adjusted for age and gender in multivariable model. HHD/HHE was associated with more rapid acquisition of infection by the HESNs (HR = 2.0, 95% CI = 1.20-3.43, P = 0.008), after adjustments for index partner VL and the presence of genital ulcer or inflammation in either partner in Cox multivariable models. The HHD/HHE effect was stronger in exposed females (HR = 2.1, 95% CI = 1.14-3.95, P = 0.018).ConclusionsAmong Zambian discordant couples, HIV-1 coreceptor gene haplotypes and diplotypes appear to modulate HIV-1 VL in seroconverters and alter the rate of HIV-1 acquisition by HESNs. These associations replicate or resemble findings reported in other African and European populations.

HIV-1 transmission among HIV-1 discordant couples before and after the introduction of antiretroviral therapy

To evaluate the impact of antiretroviral therapy (ART) on HIV-1 transmission rates among HIV-1 discordant couples in Rakai, Uganda. Observational cohort study. HIV-1 discordant couples were retrospectively identified between 2004 and 2009. Study participants underwent annual screening for HIV-1 and were interviewed to evaluate risk behaviors. Participants were offered voluntary counseling and testing and provided with risk reduction counseling. Free ART was offered to participants with a CD4 cell count of 250 cells/μl or less or WHO stage IV disease. HIV-1 incidence and sexual risk behaviors were compared before and after the HIV-1-positive index partners started ART. Two hundred and fifty HIV-1 discordant couples were followed between 2004 and 2009 and 32 HIV-1-positive partners initiated ART. Forty-two HIV-1 transmissions occurred over 459.4 person-years prior to ART initiation, incidence 9.2/100 person-years [95% confidence interval (CI) 6.59-12.36]. In 32 couples in which the HIV-1 index partners started ART, no HIV-1 transmissions occurred during 53.6 person-years. The 95% CI for the incidence rate difference was -11.91 to -6.38 (P = 0.0097). Couples reported more consistent condom use during ART use, but there was no significant difference in the number of sexual partners or other risk behaviors. Viral load was markedly reduced in persons on ART. HIV-1 transmission may be reduced among HIV-1 discordant couples after initiation of ART due to reductions in HIV-1 viral load and increased consistent condom use.

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.

Expedited Partner Treatment for Sexually Transmitted Infections: An Update

To date, seven randomized trials have evaluated the efficacy of expedited partner treatment (EPT). These trials have included heterosexual men and women and examine EPT for Chlamydia trachomatis, Neisseria gonorrhoea, and Trichomonas vaginalis. These studies demonstrated either superiority for percentage of partners being treated, for a reduction in repeat infections, or cost benefit for EPT compared to the standard partner referral method and reported no adverse events. In the United States, although the number of states where EPT is legal continues to grow, adoption of EPT remains low. Provider concerns about liability and payment issues continue to be a barrier to implementation of EPT. More translational research is needed to improve adoption by the players involved: index patients, partners, providers, and payers.

HIV status in discordant couples in sub-Saharan Africa: a systematic review and meta-analysis

Most couples affected by HIV/AIDS in sub-Saharan Africa live in discordant relationships. Men are thought to be the index case in most relationships, and most social marketing and awareness campaigns are focused on men. We investigated serodiscordance in stable relationships to establish the gender balance of index-case infections. We did a systematic review, random-effects meta-analysis, and meta-regression of published and unpublished studies enrolling discordant couples and assessed the proportion of men and women that were index cases. We repeated the analysis with data from demographic and health surveys (DHS) from the 14 countries that have documented the HIV status of couples. Our primary outcome was the total number of HIV discordant couples, including the proportion of HIV-positive women. We included data from 27 cohorts of 13,061 couples and DHS data from 14 countries of 1145 couples. The proportion of HIV-positive women in stable heterosexual serodiscordant relationships was 47% (95% CI 43-52), which shows that women are as likely as men to be the index partner in a discordant couple. DHS data (46%, 41-51) and our sensitivity analysis (47%, 43-52) showed similar findings. Meta-regression showed that urban versus rural residence (odds ratio 0.31, 95% CI 0.22-0.39), latitude (β coefficient 0.02, 0.023-0.034), gender equality (β coefficient -0.42, -0.56 to -0.27), HIV prevalence (β coefficient -0.037, -0.04 to -0.030), and older age (β coefficient 0.20, 0.08-0.32) were associated with the proportion of female index cases. Our study shows the need to focus on both sexes in HIV prevention strategies, such as promotion of condom use and mitigation of risk behaviours. None.

Recruiting heterosexual couples from the general population for studies in rural South Africa – challenges and lessons (Project Accept, HPTN 043)

Couples should be included in HIV prevention research, but their recruitment in southern Africa is challenging given high levels of migration and non-cohabitation. We describe the recruitment strategies and experiences of a pilot study in rural South Africa. With the aim of recruiting 20 couples at mobile voluntary counselling and testing (VCT) caravans and community venues, 75 index partners were screened with an average of 4 additional contacts required to schedule interviews. Recruiting and interviewing couples is feasible, but requires substantial resources.

Honing the Test-and-Treat HIV Strategy

In his News Focus story (“Treatment as prevention,” 5 March, p. [1196][1]), J. Cohen reviews ideas presented at the 17th Conference on Retroviruses and Opportunistic Infections about the use of HIV treatment as prevention. Enthusiasm for the treatment-as-prevention approach has grown in recent years as (i) the drugs have become safer, better tolerated, and more widely available; (ii) widespread testing has become cheaper and more efficient; (iii) earlier therapy has become desirable; and (iv) mathematical modeling by some ([ 1 ][2]) (but by no means all) has suggested that a test-and-treat strategy could control the spread of HIV. Cohen cites an observational analysis, by Donnell et al. , that reported considerable reduction of HIV transmission in HIV discordant couples when ART was provided to the HIV-infected index partner ([ 2 ][3]). This finding—similar to work from Sullivan et al. presented at Conference on Retroviruses and Opportunistic Infections in 2009 ([ 3 ][4])—helps to support the key assumption that ART reduces infectiousness. However, these studies report only short-term observations; they do not address the durability of this effect or the risk of transmitted drug-resistant HIV strains, two critical considerations for the test-and-treat strategy. 1. [↵][5] 1. R. M. Granich, 2. C. F. Gilks, 3. C. Dye, 4. K. M. De Cock, 5. B. G. Williams , Lancet 373, 48 (2009). [OpenUrl][6][CrossRef][7][PubMed][8][Web of Science][9] 2. [↵][10] 1. D. Donnell 2. et al ., abstract 136, presented at the 17th Conference on Retroviruses and Opportunistic Infections, San Francisco, CA, 16 to 19 February 2010. 3. [↵][11] 1. P. Sullivan 2. et al ., abstract 52bLB, presented at the 16th Conference on Retroviruses and Opportunistic Infections, Montreal, Canada, 8 to 11 February 2009. [1]: /lookup/doi/10.1126/science.327.5970.1196-b [2]: #ref-1 [3]: #ref-2 [4]: #ref-3 [5]: #xref-ref-1-1 View reference 1 in text [6]: {openurl}?query=rft.jtitle%253DLancet%26rft.stitle%253DLancet%26rft.aulast%253DGranich%26rft.auinit1%253DR.%2BM.%26rft.volume%253D373%26rft.issue%253D9657%26rft.spage%253D48%26rft.epage%253D57%26rft.atitle%253DUniversal%2Bvoluntary%2BHIV%2Btesting%2Bwith%2Bimmediate%2Bantiretroviral%2Btherapy%2Bas%2Ba%2Bstrategy%2Bfor%2Belimination%2Bof%2BHIV%2Btransmission%253A%2Ba%2Bmathematical%2Bmodel.%26rft_id%253Dinfo%253Adoi%252F10.1016%252FS0140-6736%252808%252961697-9%26rft_id%253Dinfo%253Apmid%252F19038438%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [7]: /lookup/external-ref?access_num=10.1016/S0140-6736(08)61697-9&link_type=DOI [8]: /lookup/external-ref?access_num=19038438&link_type=MED&atom=%2Fsci%2F328%2F5981%2F976.atom [9]: /lookup/external-ref?access_num=000262183800031&link_type=ISI [10]: #xref-ref-2-1 View reference 2 in text [11]: #xref-ref-3-1 View reference 3 in text

HIV-1 Transmitting Couples Have Similar Viral Load Set-Points in Rakai, Uganda

It has been hypothesized that HIV-1 viral load set-point is a surrogate measure of HIV-1 viral virulence, and that it may be subject to natural selection in the human host population. A key test of this hypothesis is whether viral load set-points are correlated between transmitting individuals and those acquiring infection. We retrospectively identified 112 heterosexual HIV-discordant couples enrolled in a cohort in Rakai, Uganda, in which HIV transmission was suspected and viral load set-point was established. In addition, sequence data was available to establish transmission by genetic linkage for 57 of these couples. Sex, age, viral subtype, index partner, and self-reported genital ulcer disease status (GUD) were known. Using ANOVA, we estimated the proportion of variance in viral load set-points which was explained by the similarity within couples (the ‘couple effect’). Individuals with suspected intra-couple transmission (97 couples) had similar viral load set-points (p = 0.054 single factor model, p = 0.0057 adjusted) and the couple effect explained 16% of variance in viral loads (23% adjusted). The analysis was repeated for a subset of 29 couples with strong genetic support for transmission. The couple effect was the major determinant of viral load set-point (p = 0.067 single factor, and p = 0.036 adjusted) and the size of the effect was 27% (37% adjusted). Individuals within epidemiologically linked couples with genetic support for transmission had similar viral load set-points. The most parsimonious explanation is that this is due to shared characteristics of the transmitted virus, a finding which sheds light on both the role of viral factors in HIV-1 pathogenesis and on the evolution of the virus.

Killer immunoglobulin-like receptor genes and heterosexual HIV-1 transmission

Methods Between 1995 and 2006, 566 HIV-1 serodiscordant couples in Zambia, were followed for counseling and serologic testing for a minimum of nine months. KIR genes and HLA alleles were detected by standard typing methods. We tested the association of KIR genes and KIR gene/HLA ligand combinations with HIV-1 transmission and with index partner viral load (VL). All analyses of VL by linear regression were adjusted for age, sex, and time from enrollment. Covariates in proportional hazards models of HIV-1 transmission included VL in all index partners and genital ulcers in all partners.

Combined antiretroviral treatment and heterosexual transmission of HIV-1: cross sectional and prospective cohort study

Objective To estimate the risk and probability of heterosexual transmission of HIV-1 from infected people taking combined antiretroviral treatment.Design Cross sectional and prospective cohort studies.Setting HIV clinic in Madrid, Spain.Participants...

Costs and Effectiveness of Partner Counseling and Referral Services With Rapid Testing for HIV in Colorado and Louisiana, United States

Health departments offer partner counseling and referral services (PCRS) to HIV-infected index patients and their partners. Point-of-care rapid HIV testing makes it possible for partners of index patients to learn their HIV serostatus in nonclinical settings. We assessed costs and effectiveness of PCRS with rapid HIV testing in Colorado and Louisiana (April 2004-January 2006). Colorado provided PCRS to the index patients and partners statewide; Louisiana provided PCRS to those in Baton Rouge and New Orleans. The key effectiveness measures were number of partners tested and number of partners informed of a new HIV diagnosis after rapid testing. We obtained program costs for personnel, travel, utilities, supplies, equipment, and facility space. Colorado identified a yearly average of 328 index patients and 253 partners and tested 43 partners. Louisiana identified a yearly average of 81 index patients and 138 partners and tested 83 partners. The rates of previously undiagnosed HIV infection among partners tested were 6.6% in Colorado and 9.9% in Louisiana. The average costs per partner tested and per partner informed of a new HIV diagnosis were $1459 and $22,243 in Colorado and $714 and $7231 in Louisiana. Program costs varied substantially by location. Our analysis helps program managers and health care providers to understand the resources needed for implementing the PCRS in diverse settings.