Risk factors for HIV transmission among serodiscordant couples in Henan Province, China

1. Risk factors for HIV transmission among serodiscordant couples in Henan Province, China Jing Luo MD, Zeng Ge MS, Lu Wang MD, Duo Shan MS, Xing Gao MD/PHD, Guo-wei Ding MD, Jian-Ping Zhou BS, Wen-Sheng He BS, Ning Wang MD/PHD, Han-Zhu Qian, MD/PHD Yale Primary Care Internal Medicine Residency Program, New Haven and Waterbury, Connecticut  Background Results Seventy one percent of index spouses were on ART, and ART use was associated with decreased risk for HIV transmission, but this result was not statistically significant (RR=0.76; 95% CI, 0.45-1.28). There was no association between rate of HIV seroconversion and level of the last recorded CD4 count in the index spouse. Comparison of risk factors associated with HIV seroconversion among 1927 initially HIV-negative spouses in Zhumadian city. At the end of 2009, the estimated number of people living with HIV in China was 740,000. Women accounted for 30.5% of these cases. Prevalence among the population as a whole was 0.057%. It is estimated that 48,000 people were newly infected with HIV in 2009. Of the 740,000 people estimated to be living with HIV in 2009, the percentage infected through sexual transmission reached 59.0%. 44.3% were infected through heterosexual transmission and 14.7% through homosexual transmission. Overall, China is still experiencing a low-prevalence epidemic, with some key regions experiencing high prevalence epidemics. However, the epidemic has already started to spread from high-risk populations to the general population. Out of 1927 couples, 84 (4.3%) seroconversions occurred, representing a seroconversion rate of 1.71 per 100 person-years. The cumulative incidence rate was 4.92% and seroconversion rates increased over time. Not always using condoms (RR=8.42; 95% CI, 4.83-14.67), sexual activity ≥ 4 times per month (RR=5.24; 95% CI, 2.55-10.77), not switching anti-retroviral treatment (ART) regimen (RR=1.99; 95% CI, 0.85-4.65), and a quality of life score < 12 on the psychological domain (RR=2.33; 95% CI, 1.21-4.48) were associated with increased risk of seroconversion. Objective Discussion To estimate the HIV incidence and assess the behavioral, clinical, and quality-of-life risk factors for HIV transmission among serodiscordant couples from Henan Province, China. Our study of 1927 HIV discordant couples in Zhumadian city, Henan province is the largest of its kind in China and found an incidence rate of 1.71 per 100 person-years. This suggests that HIV-negative spouses living in discordant relationships in Zhumadian could be considered one of China’s high-risk groups. Overall, seroconversion rates increased as duration of follow-up lengthened. Switching ART regimens was associated with decreased risk of HIV transmission. Effective HIV prevention interventions targeting discordant couples should focus on sustaining health education, increasing psychosocial support services, and increasing medication adherence monitoring. Methods Between January 2006 and December 2008, 1927 initially seronegative spouses were tested for HIV at six month intervals. Retrospectively identified subjects were interviewed through face-to-face questionnaire. Cox proportional-hazards model was used to assess the relationship between risk factors and HIV seroconversion.