Sawada Ikumi, Tanuma Junko, Do Cuong Duy, Doan Tra Thu, Luu Quynh Phuong, Nguyen Lan Anh Thi, Vu Tuong Van Thi, Nguyen Tuan Quang, Tsuchiya Naho, Shiino Teiichiro, Yoshida Lay-Myint, Pham Thanh Thuy Thi, Ariyoshi Koya, Oka Shinichi
Department of Clinical Tropical Medicine, Institute of Tropical Medicine, Graduate School of Biomedical Science, Nagasaki University, Nagasaki, Japan; AIDS Clinical Center, National Center of Global Health and Medicine, Tokyo, Japan.
AIDS Clinical Center, National Center of Global Health and Medicine, Tokyo, Japan.
PLoS One. 2015 Apr 21;10(4):e0125299. doi: 10.1371/journal.pone.0125299. eCollection 2015.
Little is known about the state of HIV transmission among married couples in Vietnam. This study aims to clarify HIV serostatus in this group and elucidate risk factors for intra-marital HIV transmission.
In 2012, we enrolled a group of HIV-positive married men registered at the HIV outpatient clinic of a referral hospital in northern Vietnam, along with their wives. Sociodemographic, behavioural and clinical data were collected from men and wives. HIV serodiscordant couples were followed until March 2014 to determine seroconversion rate. A phylogenetic analysis was performed based on env V3 sequence to detail cluster formation among men.
Of the 163 HIV-positive men enrolled in the study, 101 (62.0%) had wives testing HIV-negative. Half of men reported injecting drug use (IDU) as a likely transmission route. Couples reported a high incidence of unprotected sexual intercourse prior to diagnosis; the median (inter quartile range) was 4 (4-8) times per month. Only 17 couples (10.4%) reported using condoms during at least half these instances. Multivariable analysis revealed IDU history among men was independently associated with HIV-negative wives (adjusted OR 0.31; 95% CI 0.10-0.95, p=0.041). Phylogenetic analysis of 80 samples indicated CRF01_AE. Of these, 69 (86.3%) clustered with IDU-associated viruses from Vietnam. No HIV seroconversion was identified during a follow-up of 61 serodiscordant couples, with 126.5 person-years of observation during which HIV-infected men were on antiretroviral drug therapy (ART).
High HIV serodiscordance was observed among HIV-affected married couples in northern Vietnam. A large number of at-risk wives therefore remain HIV-negative and can be protected with measures including proper use of ART if couples are made aware of the serodiscordance through screening.
越南已婚夫妇间的艾滋病毒传播状况鲜为人知。本研究旨在明确该群体的艾滋病毒血清学状态，并阐明婚内艾滋病毒传播的危险因素。
2012年，我们招募了一组在越南北部一家转诊医院的艾滋病毒门诊登记的艾滋病毒阳性已婚男性及其妻子。收集了男性和妻子的社会人口统计学、行为和临床数据。对艾滋病毒血清学不一致的夫妇进行随访，直至2014年3月，以确定血清转换率。基于env V3序列进行系统发育分析，以详细了解男性中的聚类形成情况。
在参与研究的163名艾滋病毒阳性男性中，101名（62.0%）的妻子艾滋病毒检测呈阴性。一半的男性报告注射吸毒（IDU）为可能的传播途径。夫妇们报告在诊断前无保护性行为的发生率很高；中位数（四分位间距）为每月4次（4 - 8次）。只有17对夫妇（10.4%）报告在至少一半的此类情况中使用了避孕套。多变量分析显示，男性的注射吸毒史与艾滋病毒阴性的妻子独立相关（调整后的比值比为0.31；95%置信区间为0.10 - 0.95，p = 0.041）。对80个样本的系统发育分析表明为CRF01_AE。其中，69个（86.3%）与来自越南的与注射吸毒相关的病毒聚类。在对61对血清学不一致的夫妇进行随访期间，未发现艾滋病毒血清转换，在此期间，艾滋病毒感染男性接受抗逆转录病毒药物治疗（ART）的观察人年数为126.5。
在越南北部受艾滋病毒影响的已婚夫妇中观察到高艾滋病毒血清学不一致率。因此，大量有风险的妻子仍为艾滋病毒阴性，如果通过筛查让夫妇了解血清学不一致情况，可采取包括正确使用抗逆转录病毒治疗在内的措施对她们进行保护。
