Sero-conversion rate and its predictors among HIV discordant couples at Jimma University Specialized Hospital

Abstract

Background: All HIV-1 transmissions occur from an infected to an uninfected partner, but subSaharan Africa is unique in that a high proportion of HIV-1 transmissions may occur in stable, long-term partnerships, in which one member is HIV-1-infected. Although this has been reported from other countries, there is no study done in Ethiopia on sero-conversion rate and its predictors in HIV discordant couples. Objectives: To assess the incidence of and risk factors for HIV acquisition in a cohort of HIVuninfected partners from HIV discordant couples in Jimma University Specialized Hospital (JUSH) Anti Retroviral Treatment (ART) clinic. Methods: A retrospective cohort study was conducted at ART clinic and VCT center of Jimma University Specialized Hospital (JUSH) from November 16/2013 to February 15/2014 on 322 sero-discordant couples that are selected from the registered clients in the period from 2003 to 2013 in JUSH Voluntary Counseling and Testing (VCT) center. A structured questioner was used to collect data on socio-demographic characteristics, duration since the participants knew their HIV serostatus, social and behavioral characteristics and clinical and immunological characteristics. HIV-uninfected adults living in HIV discordant couple relationships were counseled and tested for HIV. The data was collected by medical resident physicians working at the ART clinic of the hospital. Data was cleaned, edited and entered to SPSS version 16.0 computer software for analysis. The survival analysis and determination of risk factors for HIV acquisition was done using Cox regression model. The value of p < 0.05 was considered statistically significant. Results: The overall HIV incidence rate was 1.7; and 1.8 and 1.6 per 100 PYO in men and women respectively. In the follow-up risk analysis, Late WHO stage at enrollment was predictive of a reduced risk of HIV acquisition [Stage II, (adjusted risk ratio [aRR] = 0.2, 95% confidence interval [CI]=0.06-0.83);Stage III (aRR = 0.03, 95% CI = 0.04-0.27)] and no seroconversion occurred in HIV-uninfected partners whose partners were in WHO clinical stage IV.. There were no seroconversions among participants who reported consistent condom use during the study. Conclusion: Our study found a low rate of HIV transmission among serodiscordant couples in the study area, but it contributes to a clinically significant population that mandates implementation of preventive strategy. Antiretroviral Therapy programs should be combined with HIV prevention interventions that emphasize always using condoms.