Objectives: 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.
Methods: Between January 2006 and December 2008, initially seronegative spouses were tested for HIV at 6-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.
Results: Of 1927 couples, 84 (4.3%) seroconversions occurred, representing a seroconversion rate of 1.71 per 100 person-years. Seroconversion rates increased over time. Not always using condoms [relative ratio (RR) = 8.42; 95% confidence interval (CI): 4.83 to 14.67], sexual activity ≥4 times per month (RR = 5.24; 95% CI: 2.55 to 10.77), not switching antiretroviral treatment regimen (RR = 1.99; 95% CI: 0.85 to 4.65), and a quality-of-life score <12 on the psychological domain (RR = 2.33; 95% CI: 1.21 to 4.48) were associated with increased risk of seroconversion. Seventy-one percent of index spouses were on antiretroviral therapy. There was no association between rate of HIV seroconversion and last recorded CD4 cell count level of the index spouse.
Conclusions: Effective HIV prevention interventions targeting discordant couples should focus on sustaining health education, increasing psychosocial support services, and increasing medication adherence monitoring.
From the *Department of Epidemiology, National Center for AIDS/STD Control & Prevention, Chinese Center for Disease Control & Prevention, Beijing, China; †School of Public Health, Peking Union Medical College, Beijing, China; ‡University of Illinois at Chicago College of Medicine, Chicago, IL; and §Zhumadian Center for Disease Control and Prevention, Zhumadian City, Henan Province, China.
Received for publication February 25, 2010; accepted May 25, 2010.
Supported by the megaprojects of national science research for the 11th 5-Year Plan (2008ZX10001-001) of China and the Fogarty International Center, National Institutes of Health Office of the Director, Office of AIDS Research, National Cancer Center, National Eye Institute, National Heart, Blood, and Lung Institute, National Institute of Dental and Craniofacial Research, National Institute On Drug Abuse, National Institute of Mental Health, and National Institute of Allergy and Infectious Diseases Health, through the International Clinical Research Fellows Program at Vanderbilt (R24 TW007988).
Part of this work has been submitted as an abstract to the International AIDS Conference, July 18-23, 2010, Vienna, Austria.
The authors L.W. and Z.G. contributed equally to this article.
Correspondence to: Wang Ning, MD, PhD, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, No 27 Nanwei Road, Xuanwu District, Beijing 100050, P. R. China (e-mail: firstname.lastname@example.org).