Joseph Davey Dvora L, Wall Kristin M, Kilembe William, Naw Htee Khu, Brill Ilene, Vwalika Bellington, Chomba Elwyn, Mulenga Joseph, Tichacek Amanda, Javanbakt Marjan, Gorbach Pamina M, Allen Susan A
*Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, GA; †Department of Epidemiology, Fielding School of Public Health, UCLA, Los Angeles, CA; ‡Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; §Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Birmingham, AL; ‖Department of Gynecology and Obstetrics, School of Medicine, University of Zambia, Lusaka, Zambia; and ¶Ministry of Community Development, Mother and Child Health, Lusaka, Zambia.
J Acquir Immune Defic Syndr. 2017 Oct 1;76(2):123-131. doi: 10.1097/QAI.0000000000001494.
Evaluate the incidence and predictors of HIV acquisition from outside partners in serodiscordant couples.
Demographic, behavioral, and clinical exposures were measured quarterly in a cohort of serodiscordant cohabiting couples in Zambia from 1995 to 2012 (n = 3049). Genetic analysis classified incident infections as those acquired from the study partner (linked) or acquired from an outside partner (unlinked). Factors associated with time to unlinked HIV infection were evaluated using multivariable Cox proportional hazards regression stratified by sex.
There were 100 unlinked infections in couples followed for a median of 806 days. Forty-five infections occurred in women [1.85/100 couple-years; 95% confidence interval (CI): 1.35 to 2.47]. Risk of female unlinked infection (vs. nonseroconverting females) was associated with reporting being drunk weekly/daily vs. moderate/nondrinkers at baseline [adjusted hazard ratio (aHR) = 5.44; 95% CI: 1.03 to 28.73], genital ulcers (aHR = 6.09; 95% CI: 2.72 to 13.64), or genital inflammation (aHR = 11.92; 95% CI: 5.60 to 25.37) during follow-up adjusting for age, years cohabiting, income, contraceptive use, previous pregnancies, history of sexually transmitted infections, and condomless sex with study partner. Fifty-five infections occurred in men (1.82/100 couple-years; 95% CI: 1.37 to 2.37). Risk of male unlinked infection was associated with genital inflammation (aHR = 8.52; 95% CI: 3.82 to 19.03) or genital ulceration (aHR = 2.31; 95% CI: 2.05 to 8.89), reporting ≥1 outside sexual partner (aHR = 3.86; 95% CI: 0.98 to 15.17) during follow-up, and reporting being drunk weekly/daily vs. moderate/nondrinkers at baseline (aHR = 3.84; 95% CI: 1.28 to 11.55), controlling for age, income, circumcision status, and history of sexually transmitted infection.
Predictors of unlinked infection in serodiscordant relationships were alcohol use, genital inflammation, and ulceration. Causes of genital inflammation and ulceration should be screened for and treated in HIV-negative individuals. Counseling on risk of alcohol use and sex with outside partners should be discussed with couples where 1 or both are HIV-negative, including in counseling on use of pre-exposure prophylaxis to prevent HIV acquisition in the HIV-negative partner (when feasible and affordable).
评估血清学不一致的伴侣中从外部性伴侣感染艾滋病毒的发生率及预测因素。
1995年至2012年期间，对赞比亚一组血清学不一致的同居伴侣队列（n = 3049）每季度进行人口统计学、行为学和临床暴露情况测量。基因分析将新发感染分为从研究伴侣处获得（相关）或从外部性伴侣处获得（不相关）。使用按性别分层的多变量Cox比例风险回归评估与不相关艾滋病毒感染时间相关的因素。
在随访时间中位数为806天的伴侣中，有100例不相关感染。45例感染发生在女性中[1.85/100人年；95%置信区间（CI）：1.35至2.47]。女性不相关感染风险（与未血清转化的女性相比）与基线时报告每周/每天醉酒与适度饮酒者/不饮酒者相比有关[调整后风险比（aHR）= 5.44；95% CI：1.03至28.73]，随访期间有生殖器溃疡（aHR = 6.09；95% CI：2.72至13.64）或生殖器炎症（aHR = 11.92；95% CI：5.60至25.37），对年龄、同居年限、收入、避孕措施使用、既往妊娠、性传播感染史以及与研究伴侣无保护性行为进行了调整。55例感染发生在男性中（1.82/100人年；95% CI：1.37至2.37）。男性不相关感染风险与生殖器炎症（aHR = 8.52；95% CI：3.82至19.03）或生殖器溃疡（aHR = 2.31；95% CI：2.05至8.89）、随访期间报告有≥1个外部性伴侣（aHR = 3.86；95% CI：0.98至15.17）以及基线时报告每周/每天醉酒与适度饮酒者/不饮酒者相比有关（aHR = 3.84；95% CI：1.28至11.55），对年龄、收入、包皮环切状态和性传播感染史进行了控制。
血清学不一致关系中不相关感染的预测因素是饮酒、生殖器炎症和溃疡。应对艾滋病毒阴性个体筛查并治疗生殖器炎症和溃疡的病因。对于一方或双方为艾滋病毒阴性的伴侣，应讨论饮酒风险及与外部性伴侣发生性行为的问题，包括在关于使用暴露前预防措施以防止艾滋病毒阴性伴侣感染艾滋病毒的咨询中（在可行且可负担的情况下）。
