Medical Research Council (MRC)/Uganda Virus Research Institute (UVRI) Uganda Research Unit on AIDS, Entebbe, Uganda.
PLoS One. 2013;8(2):e55060. doi: 10.1371/journal.pone.0055060. Epub 2013 Feb 4.
Early initiation of antiretroviral therapy reduces risk of transmission to the uninfected partner in HIV discordant couples, but there are relatively little observational data on HIV transmission within couples from non-trial settings. The aims of this paper are to estimate HIV incidence among HIV discordant couples using longstanding observational data from a rural Ugandan population and to identify factors associated with HIV transmission within couples, including the role of HSV-2 infection.
Using existing data collected at population-wide annual serological and behavioural surveys in a rural district in southwest Uganda between 1989 and 2007, HIV discordant partners were identified. Stored serum samples were tested for HSV-2 serostatus using the Kalon ELISA test. HIV seroconversion rates and factors association with HIV seroconversion were analysed using Poisson regression.
HIV status of both partners was known in 2465 couples and of these 259 (10.5%) were HIV serodiscordant. At enrollment, HSV-2 prevalence was 87.3% in HIV positive partners and 71.5% in HIV negative partners. Of the 259 discordant couples, 62 converted to HIV (seroconversion rate 7.11/100 PYAR, 95%CI; 5.54, 9.11) with the rate decreasing from 10.89 in 1990-1994 to 4.32 in 2005-2007. Factors independently associated with HIV seroconversion were female sex, non-Muslim religion, greater age difference (man older than woman by more than 15 years), higher viral load in the positive partner and earlier calendar period. HSV-2 was not independently associated with HIV acquisition (HR 1.62, 95%CI; 0.57, 4.55) or transmission (HR 0.61, 95%CI; 0.24, 1.57). No transmissions occurred in the 29 couples where the index partner was on ART during follow up (872 person-years on ART).
HIV negative partners in serodiscordant couples have a high incidence of HIV if the index partner is not on antiretroviral therapy and should be provided with interventions such as couple counselling, condoms and antiretroviral treatment.
在 HIV 不一致的夫妇中，早期开始抗逆转录病毒治疗可降低将病毒传染给未感染伴侣的风险，但来自非试验环境的夫妇间 HIV 传播的观察性数据相对较少。本文的目的是使用乌干达农村地区长期的观察性数据，估算 HIV 不一致夫妇中的 HIV 发病率，并确定与夫妇间 HIV 传播相关的因素，包括单纯疱疹病毒 2 型（HSV-2）感染的作用。
利用乌干达西南部一个农村地区在 1989 年至 2007 年期间进行的人群年度血清学和行为调查中收集的现有数据，确定 HIV 不一致的伴侣。使用 Kalon ELISA 试验检测储存的血清样本中 HSV-2 的血清状态。使用泊松回归分析 HIV 血清转换率和与 HIV 血清转换相关的因素。
在 2465 对伴侣中，双方的 HIV 状况均已知，其中 259 对（10.5%）为 HIV 不一致。在入组时，HIV 阳性伴侣的 HSV-2 流行率为 87.3%，HIV 阴性伴侣的流行率为 71.5%。在 259 对不一致的夫妇中，有 62 对转为 HIV（血清转换率为 7.11/100 人年，95%CI；5.54，9.11），这一比例从 1990-1994 年的 10.89%降至 2005-2007 年的 4.32%。与 HIV 血清转换独立相关的因素包括女性、非穆斯林宗教信仰、年龄差异较大（男性比女性大 15 岁以上）、阳性伴侣的病毒载量较高和较早的日历时间。HSV-2 与 HIV 获得（HR 1.62，95%CI；0.57，4.55）或传播（HR 0.61，95%CI；0.24，1.57）均无独立相关性。在 29 对随访期间指数伴侣接受抗逆转录病毒治疗的夫妇中（872 人年接受 ART），没有传播发生。
如果指数伴侣未接受抗逆转录病毒治疗，HIV 不一致的夫妇中的 HIV 阴性伴侣 HIV 发病率较高，应提供伴侣咨询、避孕套和抗逆转录病毒治疗等干预措施。
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