HIV Transmission Between Couples And Its Influencing Factors In Guangxi Province

Objective(1)To understand the status of HIV transmission between couples and HIV infections from outside the marriage in Guangxi province.(2)To understand the HIV seroconversion rate of negative partners and analyze the preventive effect of antiviral treatment to HIV negative partners.(3)To explore the influencing factors of HIV seroconversion of negative partners in discordant couples and give scientific evidence for further curb the spread of HIV/AIDS.MethodsThe data of HIV/AIDS patients infected through positive partners based on Guangxi AIDS prevention and control information management system were analyzed by descriptive study.HIV discordant couples were chosed from Jan 1,2003 to Dec 31,2014.HIV discordant couples were divided into different groups according whether accept antiviral treatment,the antiviral treatment begin time and the first follow-up time,and then HIV seroconversion rate was calculated.Time-dependent Cox Model was used to analyze the preventive effect of antiviral treatment.Compared the HIV seroconversion rate before and after 2008 enrolled,analyzed the preventive effect of antiviral treatment after expanding treatment coverage.Sampling survey was carried out among HIV/AIDS families,collected 10 ml of blood samples to detect HIV viral load,HBV and HCV antibody.Molecular analysis was used to identify the transmission relationship among HIV concordant couples.Through questionnaire survey to understand the information of research objects,such as demographic characteristic,behavior characteristic and antiviral treatment and so on.A case control study based on investigation both husband and wife was done to analyze influencing factors of seroconversion of HIV discordant couples.Result(1)Guangxi AIDS case report card database had reported 97389 cases until December 31,2014.Among them,9025 cases were infected through HIV positive partners.The proportion of HIV transmission between spouses showed a rising trend year by year,mainly male to female.(2)During the observation from 2003 to 2014,8179 serodiscordant couples were followed,with 447 seroconversions occurred.The total rates of HIV infection were 2.4 per 100 person-years,and 4.2/100 person years among treatment naive cohort,1.6/100 person years among treated cohort.We calculated a 45%relative reduction in HIV transmission(AHR 0.55,95%CI:0.44-0.69)in the treated cohort.The prevetive effect after 2008 was higher than before 2008,respectively 45%(AHR 0.55,95%CI:0.43-0.69)and 39%(AHR 0.61,95%CI:0.29-1.29).(3)There were 397 HIV/AIDS families in the sampling survey.61.2%of the index patients were discovered when going to the hospital,75.6%of the index patients informed their spouses the result of diagnose HIV infection in a month,however,2.3%of them didn’t inform their spouses.There were 19.9%of the families had no sexual behavior with their spouses after diagnose HIV infection.After index patients infected with HIV,seroconversion couples answered never used condoms in sexual behavior and use condoms every time were 19.0%and 49.0%respectively,serodiscordant couples were 4.2%and 86.1%respectively.The results of discontinuous usage of condoms were no need,forget to use,want a child and use up.(4)Among the 397 families,88.9%of the index patients had accepted antiviral treatment,and 41.1%of them received antiviral treatment in one month after HIV diagnosis.61.5%patients occurred side effects at the first beginning month,46.7%patients had changed treatment protocols during the process.43.0%of the cause was that the side effects of drug were too big.(5)In the survey of 200 families both living with HIV,44.0%of the spouses were positive at first follow-up test.128 couple sequences were obtained,86.7%of the couple sequences were link,13.3%of the couple sequences were unlink.(6)Without considering the spread outside the marriage,the result of the case control study with 112 seroconversion couples and 197 serodiscordant couples showed that the treatment in index patients(OR=0.056,95%CI:0.028～0.110),education(OR=1.984,95%CI:1.060～3.714)and condom use(OR=0.118,95%CI:0.058-0.240)were influence factors of HIV transmission between couples.Considering the spread outside the marriage,the result of the case control study with 63 seroconversion couples and 197 serodiscordant couples showed that the treatment in index patients(OR=0.036,95%CI:0.016～0.082),age(OR=3.321,95%CI:1.314-8.396)and condom use(OR=0.118,95%CI:0.048～0.293)were influence factors of HIV transmission between couples.Conclusion(1)HIV spread between spouses in Guangxi was severe,mainly male to female.44.0%of the spread occurd when both husband and wife didn’t know their HIV infection status.(2)The rate of HIV infection outside the families was 13.3%.(3)The rates of HIV infection among negative spouses was higher than national level,and HIV spread between spouses mainly occurred in the first three years of follow-up.(4)After expanding the coverage of antiviral treatment,the treatment as prevention approach had more remarkable effect.(5)Condom use,antiretroviral treatment and age were independent risk factors of HIV transmission between couples.