YRG Centre for AIDS Research and Education, Chennai, India.
HIV Med. 2010 Mar;11(3):178-86. doi: 10.1111/j.1468-1293.2009.00760.x. Epub 2009 Sep 24.
To assess the risk factors associated with heterosexual HIV transmission among South Indian discordant couples enrolled in clinical care.
A nested matched case-control study of serodiscordant couples in which the HIV-infected partner (index case) was enrolled in care. Demographic and clinical characteristics, sexual behaviours, CD4 cell count and plasma HIV-1 RNA loads were measured at enrollment and longitudinally over 12 months of follow-up. The study included 70 cases who seroconverted during study follow-up and 167 matched controls who remained persistently serodiscordant.
The incidence of HIV infection among the initially seronegative partners was 6.52 per 100 person-years. Persistently discordant patients were more likely to have initiated highly active antiretroviral therapy (HAART) than patients in seroconverting relationships (62.9%vs. 42.9%) (P=0.001). Patients in seroconverting relationships had significantly higher plasma viral loads (PVLs) than patients in discordant relationships at enrolment, at 6 months and at 12 months (P<0.05). Patients in seroconverting relationships were less likely to use condoms with their primary partners than patients in discordant relationships (P<0.05). Patients in relationships that seroconverted between 6 and 12 months were diagnosed more often with genital Herpes simplex than patients in discordant relationships (P=0.001). In the univariate and multivariate logistic regression, the following variables were associated with seroconversion: PVL >100,000 [odds ratio (OR): 1.82; 95% confidence interval (CI): 1.1-2.8], non-disclosure of HIV status (OR: 5.5; 95% CI: 4.3-6.2) and not using condoms (OR: 2.8; 95% CI: 2.4-3.6).
Couples-based intervention models are crucial in preventing HIV transmission to seronegative spouses. Providing early treatment for sexually transmitted infections, HAART and enhancing condom use and disclosure could potentially decrease the risk of HIV transmission within Indian married couples.
评估在接受临床护理的南印度异性恋 HIV 传播的相关风险因素。
对接受治疗的 HIV 感染者（索引病例）进行嵌套匹配病例对照研究。在纳入时以及 12 个月的随访期间，对患者的人口统计学和临床特征、性行为、CD4 细胞计数和血浆 HIV-1 RNA 载量进行测量。该研究包括 70 例在研究期间血清转换的病例和 167 例持续血清不一致的匹配对照。
最初血清阴性的伴侣中 HIV 感染的发生率为 6.52/100 人年。持续血清不一致的患者比血清转换关系的患者更有可能开始高效抗逆转录病毒治疗（HAART）（62.9%对 42.9%）（P=0.001）。在纳入时、6 个月和 12 个月时，血清转换关系中的患者的血浆病毒载量（PVL）显著高于血清不一致关系中的患者（P<0.05）。与血清不一致关系的患者相比，血清转换关系中的患者更不可能与其主要伴侣使用避孕套（P<0.05）。在 6 至 12 个月期间血清转换的患者比血清不一致关系中的患者更常被诊断为生殖器单纯疱疹（P=0.001）。在单变量和多变量逻辑回归中，以下变量与血清转换相关：PVL>100,000（比值比（OR）：1.82；95%置信区间（CI）：1.1-2.8）、未披露 HIV 状态（OR：5.5；95% CI：4.3-6.2）和未使用避孕套（OR：2.8；95% CI：2.4-3.6）。
基于夫妇的干预模式对于防止 HIV 传播给血清阴性的配偶至关重要。提供早期治疗性传播感染、HAART 以及增强避孕套使用和披露可能会降低印度已婚夫妇中 HIV 传播的风险。
