HIV incidence and predictors of HIV acquisition from an outside partner in serodiscordant couples in Lusaka, Zambia

Details

• Alternative Title:
  J Acquir Immune Defic Syndr
• Personal Author:
  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 ; Allen, Susan
• Description:
  Objective
  
  Evaluate the incidence and predictors of HIV acquisition from outside partners in serodiscordant couples.
  
  Methods
  
  Demographic, behavioral, and clinical exposures were measured quarterly in a cohort of serodiscordant cohabiting couples in Zambia from 1995-2012 (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 gender.
  
  Results
  
  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 [CY]; 95%CI:1.35-2.47). Risk of female unlinked infection (vs. non-seroconverting females) was associated with reporting being drunk weekly/daily vs. moderate/non-drinkers at baseline (aHR=5.44;95%CI:1.03-28.73), genital ulcers (aHR=6.09;95%CI:2.72-13.64) or genital inflammation (aHR=11.92;95%CI:5.60-25.37) during follow-up adjusting for age, years cohabiting, income, contraceptive use, previous pregnancies, history of sexually transmitted infections (STI), and condomless sex with study partner. Fifty-five infections occurred in men (1.82/100 CY;95%CI:1.37-2.37). Risk of male unlinked infection was associated with genital inflammation (aHR=8.52;95%CI:3.82-19.03) or genital ulceration (aHR=2.31;95% CI:2.05-8.89), reporting =>1 outside sexual partner (aHR=3.86;95%CI:0.98-15.17) during follow-up, and reporting being drunk weekly/daily vs. moderate/non-drinkers at baseline (aHR=3.84;95%CI=1.28-11.55), controlling for age, income, circumcision status, and history of STI.
  
  Conclusions
  
  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 one or both are HIV-negative, including in counseling on use of pre-exposure prophylaxis to prevent HIV acquisition in the HIV-negative partner.
  
  
• Subjects:
  Adult Alcohol Drinking Article Female Follow-Up Studies Genital Diseases, Female Genital Diseases, Male HIV Infections Humans Incidence Longitudinal Studies Male Pre-Exposure Prophylaxis Prospective Studies Risk Factors Sexually Transmitted Diseases Sexual Partners Young Adult

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• Source:
  J Acquir Immune Defic Syndr. 76(2):123-131.
• Pubmed ID:
  28737591
• Pubmed Central ID:
  PMC5597474
• Document Type:
  Journal Article
• Funding:
  P30 AI050409/AI/NIAID NIH HHS/United States ; U2G GH001443/GH/CGH CDC HHS/United States ; R01 HD040125/HD/NICHD NIH HHS/United States ; R25 TW009340/TW/FIC NIH HHS/United States ; R01 AI051231/AI/NIAID NIH HHS/United States ; R01 AI023980/AI/NIAID NIH HHS/United States ; R37 AI051231/AI/NIAID NIH HHS/United States ; R01 AI064060/AI/NIAID NIH HHS/United States ; D43 TW001042/TW/FIC NIH HHS/United States ; R01 MH066767/MH/NIMH NIH HHS/United States ; T32 MH080634/MH/NIMH NIH HHS/United States ; R01 HD072659/HD/NICHD NIH HHS/United States ; T32 DA023356/DA/NIDA NIH HHS/United States ; R01 MH095503/MH/NIMH NIH HHS/United States ; U2G PS000758/PS/NCHHSTP CDC HHS/United States ; U2G PS001904/PS/NCHHSTP CDC HHS/United States
• Place as Subject:
  Zambia
• Volume:
  76
• Issue:
  2
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:580aa829059331e89df34205e517bf922c768d6f8553abd49c8b038ff90e1a3d
• Download URL:
  https://stacks.cdc.gov/view/cdc/48204/cdc_48204_DS1.pdf
• File Type:
  [PDF - 294.30 KB ]