Identification of serodiscordant couples, their clinical and laboratory characteristics, and vulnerabilities of HIV transmission risk in Northeastern Brazil in the era of pre-exposure prophylaxis (PrEP)
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Published:
May 9, 2020
Keywords:
HIV-1, Highly Active Antiretroviral Therapy, Epidemiology
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Abstract
Objectives: To evaluate the frequency of HIV serodiscordants couples and their seronegative partners who were candidates for pre-exposure prophylaxis (PrPE), and the knowledge about behavioural measures to reduce virus transmission. Methods: The research was performed in Northeastern Brazil, from February 2016 to March 2017. Ninety HIV-positive individuals (Index) and their HIV-serodiscordant partners (n = 17) were submitted for epidemiological, clinical, and laboratory questionnaires, and for rapid laboratory tests for syphilis, hepatitis B and C. Results: High frequencies of HIV-syphilis (34.4%) and HIV-HBV (3.3%) coinfection were detected in the HIV-positive individuals. Three new HIV cases were detected in partners. Most participants in both groups (85.6%, Index; 94.1%, Partners) had an excellent degree of knowledge regarding HIV transmission, although nine seronegative HIV partners with a high risk of HIV infection were identified (53%). HIV-positive individuals had a high frequency of HIV-syphilis co-infection and 10% of them did not use antiretroviral by personal option. Conclusions: Adoption of PrEP and other preventive measures to prevent HIV transmission in serodiscordants couples should be studied and evaluated.
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1.
Monteiro MG, Farrant Braz A, Lima K, Ramos Lacerda H. Identification of serodiscordant couples, their clinical and laboratory characteristics, and vulnerabilities of HIV transmission risk in Northeastern Brazil in the era of pre-exposure prophylaxis (PrEP). HSJ [Internet]. 2020May9 [cited 2024May20];10(2):13-9. Available from: https://portalrcs.hcitajuba.org.br/index.php/rcsfmit_zero/article/view/931
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References
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20. Ngilangwa DP, Ochako R, Mboya BA, Noronha RH, Mgomella GS. Prevalence and predictors of HIV sero-discordance among cohabiting couples tested in northern Tanzania. Pan Afr Med J. 2015;22:275. doi: 10.11604/pamj.2015.22.275.5961
21. Mitchell JW, Stephenson R. HIV-negative partnered men’s willingness to use pre- exposure prophylaxis and associated factors among an internet sample of U.S. HIV- negative and HIV-discordant male couples. LGBT Health. 2015;2(1):35–40. doi: 10.1089/lgbt.2014.0092
22. Rodger AJ, Cambiano V, Bruun T, Vernazza P, Collins S, van Lunzen J, et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA. 2016;316(2):171–81. doi: 10.1001/jama.2016.5148
23. Smith C, Cook R, Rohleder P. A qualitative investigation into the HIV disclosure process within an intimate partnership: “The moment I realized that our relationship was developing into something serious, I just had to tell him.” Br J Health Psychol. 2017;22(1):110–27. doi: 10.1111/bjhp.12220
24. Del Romero J, Baza MB, Río I, Jerónimo A, Vera M, Hernando V, et al. Natural conception in HIV-serodiscordant couples with the infected partner in suppressive antiretroviral therapy. Medicine (Baltimore). 2016;95(30):e4398. doi: 10.1097/MD.0000000000004398
25. Tang H, Wu Z, Mao Y, Cepeda J, Morano J. Risk factor associated with negative spouse HIV seroconversion among sero-different couples: A nested case-control retrospective survey study in 30 counties in rural China. PLoS One. 2016;11(10): e0164761. doi: 10.1371/journal.pone.0164761
26. Wall KM, Canary L, Workowski K, Lockard A, Jones J, Sullivan P, et al. Acceptability of couples’ voluntary HIV testing among HIV-infected patients in care and their HIV- negative partners in the United States. Open AIDS J. 2016;10:1–13. Doi: 10.2174/1874613601610010001
27. Kumarasamy N, Venkatesh KK, Srikrishnan AK, Prasad L, Balakrishnan P, Thamburaj E, et al. Risk factors for HIV transmission among heterosexual discordant couples in South India. HIV Med. 2010;11(3):178–86. doi: 10.1111/j.1468-1293.2009.00760.x
28. Ravikumar B, Balakrishna P. Discordant HIV couple: Analysis of the possible contributing factors. Indian J Dermatol. 2013;58(5):405. doi: 10.4103/0019-5154.117304
29. Karim QA, Dellar RC, Bearnot B, Werner L, Frohlich JA, Kharsany AB, et al. HIV-positive status disclosure in patients in care in rural South Africa: Implications for scaling up treatment and prevention intervetions. AIDS Behav. 2015;19(2):322–9. doi: 10.1007/s10461-014-0951-4
30. Patel RC, Odoyo J, Anand K, Stanford-Moore G, Wakhungu I, Bukusi EA, et al. Facilitators and barriers of antiretroviral therapy initiation among HIV discordant couples in Kenya: Qualitative insights from a pre-exposure prophylaxis implementation study. PLoS ONE. 2016;11(12):e0168057. doi: 10.1371/journal.pone.0168057
31. Santos ÍM, da Rosa EA, Gräf T, Ferreira LGE, Petry A, Cavalheiro F, et al. Analysis of immunological, viral, genetic, and environmental factors that might be associated with decreased susceptibility to HIV infection in serodiscordant couples in Florianópolis, Southern Brazil. AIDS Res Hum Retroviruses. 2015;31(11):1116–25. doi: 10.1089/aid.2015.0168
32. Bobashev G, Norton J, Wechsberg W, Toussova O. Are you HIV invincible? A probabilistic study of discordant couples in the context of HIV transmission. PLoS One. 2014;9(5):e94799.
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34. Jones D, Kashy D, Chitalu N, Kankasa C, Mumbi M, Cook R, et al. Risk reduction among HIV-seroconcordant and -discordant couples: the Zambia NOW2 intervention. AIDS Patient Care STDS. 2014;28(8):433–41. doi: 10.1089/apc.2014.0039
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36. Brasil. Ministério da Saúde. Departamento de Vigilância, Prevenção e Controle das IST, do HIV/Aids e das Hepatites Virais [Internet]. Protocolo clínico e diretrizes terapêuticas para manejo da infecção pelo HIV em adultos. Brasília: Ministério da Saúde; 2018 [cited 2020 May 05]. 412p. Avaiable from: www.aids.gov.br/pt-br/profissionais-de-saude/hiv/protocolos-clinicos-e-manuais
37. Irungu EM, Heffron R, Mugo N, Ngure K, Katabira E, Bulya N, et al. Use of a risk scoring tool to identify higher-risk HIV-1 serodiscordant couples for an antiretroviral- based HIV-1 prevention intervention. BMC Infect. Dis. 2016;16(1):571. doi: 10.1186/s12879-016-1899-y
38. Baeten JM, Heffron R, Kidoguchi L, Mugo NR, Katabira E, Bukusi EA, et al. Integrated delivery of antiretroviral treatment and pre-exposure prophylaxis to HIV1- serodiscordant couples: A prospective implementation study in Kenya and Uganda. PLoS Med. 2016;13(8):e1002099. doi: 10.1371/journal.pmed.1002099
2. Chemaitelly H, Awad SF, Shelton JD, Abu-Raddad LJ. Sources of HIV incidence among stable couples in sub-Saharan Africa. J Int AIDS Soc. 2014;17:18765. 10.7448/IAS.17.1.18765
3. Hoagnland B, Boni RB, Moreira RI, Madruga JV, Kallas EG, Goulart SP, et al. Awareness and willingness to use pre-exposure prophylaxis (PrEP) among men who have sex with men and transgender women in Brazil. AIDS Behav. 2017;21(5):1278-87. doi: 10.1007/s10461-016-1516-5
4. Luz PM, Osher B, Grinsztejn B, Maclean RL, Losina E, Stern ME, et al. The cost-effectiveness of HIV pre-exposure prophylaxis in men who have sex with men and transgender women at high risk of HIV infection in Brazil. J Int AIDS Soc. 2018;21(3):e25096. doi: 10.1002/jia2.25096
5. Torres TS, Boni RB, Vasconcelos MTL, Luz PM, Hoagland B, Moreira RI, et al. Awareness and prevention strategies and willingness to use preexposure prophylaxis in Brazilian men who have sex with men using apps for sexual encounters: online cross-sectional study. JMIR Public Health Surveill. 2018;4(1):e11. doi: 10.2196/publichealth.8997
6. Curran K, Baeten JM, Coates TJ, Kurth A, Mugo NR, Celum C. HIV-1 prevention for HIV-1 serodiscordant couples. Curr HIV/AIDS Rep. 2012;9(2):160–70. doi: 10.1007/s11904-012-0114-z
7. Bernstein KT, Stephens SC, Moss N, Scheer S, Parisi MK, Philip SS. Partner services as targeted HIV screening - Changing the paradigm. Public Health Rep. 2014;129(Suppl 1):50–5. doi: 10.1177/00333549141291S108
8. Jones JS, Stephenson R, Wall KM, Sullivan PS. Relationship agreements and willingness to participate in couples HIV testing and counseling among heterosexuals in the U.S. Open AIDS J. 2014;8:50–7. doi: 10.2174/1874613601408010050
9. Zucchi EM, Grangeiro A, Ferraz D, Pinheiro TF, Alencar T, Feruson L, et al. Da evidência à ação: desafios do Sistema Único de Saúde para ofertar a profilaxia pré-exposição sexual (PrEP) ao HIV às pessoas em maior vulnerabilidade. Cad Saude Publica. 2018;34(7):e00206617. doi: 10.1590/0102-311x00206617
10. Pilcher CD, Bisol CA, Paganela MP, Vallabhaneni S, da Mota LR, Kato SK, Sperhacke RD, et al. Efficient identification of HIV serodiscordant couples by existing HIV testing programs in South Brazil. PLoS ONE. 2015;10(11):e0142638. doi: 10.1371/journal.pone.0142638
11. Jiang J, Yang X, Ye L, Zhou B, Ning C, Huang J, et al. Pre-exposure prophylaxis for the prevention of HIV infection in high risk populations: A meta-analysis of randomized controlled trials. PLoS One. 2014;9(2):e87674. doi: 10.1371/journal.pone.0087674
12. World Health Organization [Internet]. Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. Geneva: WHO;2015 [cited 2020 May 05]. 76p. Avaiable from: www.who.int/hiv/pub/guidelines/earlyrelease-arv/en/
13. Kilembe W, Wall KM, Mokgoro M, Mwaanga A, Dissen E, Kamusoko M, et al. Knowledge of HIV serodiscordance, transmission, and prevention among couples in Durban, South Africa. PLoS One. 2015;10(4):e0124548. doi: 10.1371/journal.pone.0124548
14. Kahle EM, Hughes JP, Lingappa JR, John-Stewart G, Celum C, Nakku-Joloba E, et al. An empiric risk scoring tool for identifying high-risk heterosexual HIV-1- serodiscordant couples for targeted HIV-1 prevention. J Acquir Immune Defic Syndr. 2013;62(3):339–47. doi: 10.1097/QAI.0b013e31827e622d
15. Kayeyi N, Fylkesnes K, Michelo C, Makasa M, Sandøy I. Decline in HIV prevalence among young women in Zambia: National-level estimates of trends mask geographical and socio-demographic differences. PLoS ONE. 2012;7(4):e33652. doi: 10.1371/journal.pone.0033652
16. Jones D, Kashy D, Villar-Loubet O, Weiss S. Enhancing acceptability and use of sexual barrier products among HIV concordant and discordant couples. AIDS Behav. 2013;17(6):2185–93. doi: 10.1007%2Fs10461-013-0449-5
17. Mehra B, Bhalla P, Rawat D, Kishore J. A study of HIV-concordant and -discordant couples attending voluntary counselling and testing services at a tertiary care center in north India. Indian J Public Health. 2015;59(4):306–9. doi: 10.4103/0019-557X.169664
18. Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde B [Internet]. Protocolo Clínico e Diretrizes Terapêuticas para Profilaxia Pré-Exposição (PrEP) de Risco à Infecção pelo HIV. Brasília: Ministério da Saúde; 2017 [updated 2018 Nov 22; cited 2020 May 05]. 48p. Avaiable from: www.aids.gov.br/pt-br/pub/2017/protocolo-clinico-e-diretrizes-terapeuticas-para-profilaxia-pre-exposicao-prep-de-risco
19. Zhang YJ, Feng XX, Fan YG, Jiang ZY, Zhong XH, Li MQ, et al. HIV transmission and related risk factors among serodiscordant couples in Liuzhou, China. J Med Virol. 2015;87(4):553–6. doi: 10.1002/jmv.24093
20. Ngilangwa DP, Ochako R, Mboya BA, Noronha RH, Mgomella GS. Prevalence and predictors of HIV sero-discordance among cohabiting couples tested in northern Tanzania. Pan Afr Med J. 2015;22:275. doi: 10.11604/pamj.2015.22.275.5961
21. Mitchell JW, Stephenson R. HIV-negative partnered men’s willingness to use pre- exposure prophylaxis and associated factors among an internet sample of U.S. HIV- negative and HIV-discordant male couples. LGBT Health. 2015;2(1):35–40. doi: 10.1089/lgbt.2014.0092
22. Rodger AJ, Cambiano V, Bruun T, Vernazza P, Collins S, van Lunzen J, et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA. 2016;316(2):171–81. doi: 10.1001/jama.2016.5148
23. Smith C, Cook R, Rohleder P. A qualitative investigation into the HIV disclosure process within an intimate partnership: “The moment I realized that our relationship was developing into something serious, I just had to tell him.” Br J Health Psychol. 2017;22(1):110–27. doi: 10.1111/bjhp.12220
24. Del Romero J, Baza MB, Río I, Jerónimo A, Vera M, Hernando V, et al. Natural conception in HIV-serodiscordant couples with the infected partner in suppressive antiretroviral therapy. Medicine (Baltimore). 2016;95(30):e4398. doi: 10.1097/MD.0000000000004398
25. Tang H, Wu Z, Mao Y, Cepeda J, Morano J. Risk factor associated with negative spouse HIV seroconversion among sero-different couples: A nested case-control retrospective survey study in 30 counties in rural China. PLoS One. 2016;11(10): e0164761. doi: 10.1371/journal.pone.0164761
26. Wall KM, Canary L, Workowski K, Lockard A, Jones J, Sullivan P, et al. Acceptability of couples’ voluntary HIV testing among HIV-infected patients in care and their HIV- negative partners in the United States. Open AIDS J. 2016;10:1–13. Doi: 10.2174/1874613601610010001
27. Kumarasamy N, Venkatesh KK, Srikrishnan AK, Prasad L, Balakrishnan P, Thamburaj E, et al. Risk factors for HIV transmission among heterosexual discordant couples in South India. HIV Med. 2010;11(3):178–86. doi: 10.1111/j.1468-1293.2009.00760.x
28. Ravikumar B, Balakrishna P. Discordant HIV couple: Analysis of the possible contributing factors. Indian J Dermatol. 2013;58(5):405. doi: 10.4103/0019-5154.117304
29. Karim QA, Dellar RC, Bearnot B, Werner L, Frohlich JA, Kharsany AB, et al. HIV-positive status disclosure in patients in care in rural South Africa: Implications for scaling up treatment and prevention intervetions. AIDS Behav. 2015;19(2):322–9. doi: 10.1007/s10461-014-0951-4
30. Patel RC, Odoyo J, Anand K, Stanford-Moore G, Wakhungu I, Bukusi EA, et al. Facilitators and barriers of antiretroviral therapy initiation among HIV discordant couples in Kenya: Qualitative insights from a pre-exposure prophylaxis implementation study. PLoS ONE. 2016;11(12):e0168057. doi: 10.1371/journal.pone.0168057
31. Santos ÍM, da Rosa EA, Gräf T, Ferreira LGE, Petry A, Cavalheiro F, et al. Analysis of immunological, viral, genetic, and environmental factors that might be associated with decreased susceptibility to HIV infection in serodiscordant couples in Florianópolis, Southern Brazil. AIDS Res Hum Retroviruses. 2015;31(11):1116–25. doi: 10.1089/aid.2015.0168
32. Bobashev G, Norton J, Wechsberg W, Toussova O. Are you HIV invincible? A probabilistic study of discordant couples in the context of HIV transmission. PLoS One. 2014;9(5):e94799.
33. Wall KM, Kilembe W, Vwalika B, Haddad LB, Lakhi S, Onwubiko U, et al. Sustained effect of couples’ HIV counselling and testing on risk reduction among Zambian HIV serodiscordant couples. Sex Transm Infect. 2017;93(4):259–66. doi: 10.1136/sextrans-2016-052743
34. Jones D, Kashy D, Chitalu N, Kankasa C, Mumbi M, Cook R, et al. Risk reduction among HIV-seroconcordant and -discordant couples: the Zambia NOW2 intervention. AIDS Patient Care STDS. 2014;28(8):433–41. doi: 10.1089/apc.2014.0039
35. UNAIDS [Internet]. Ambitious treatment targets: Writing the final chapter of the AIDS epidemic. Geneva: UNAIDS; 2014 [cited 2020 May 05]. 36p. Avaiable from: www.unaids.org/sites/default/files/media_asset/JC2670_UNAIDS_Treatment_Targets_en.pdf
36. Brasil. Ministério da Saúde. Departamento de Vigilância, Prevenção e Controle das IST, do HIV/Aids e das Hepatites Virais [Internet]. Protocolo clínico e diretrizes terapêuticas para manejo da infecção pelo HIV em adultos. Brasília: Ministério da Saúde; 2018 [cited 2020 May 05]. 412p. Avaiable from: www.aids.gov.br/pt-br/profissionais-de-saude/hiv/protocolos-clinicos-e-manuais
37. Irungu EM, Heffron R, Mugo N, Ngure K, Katabira E, Bulya N, et al. Use of a risk scoring tool to identify higher-risk HIV-1 serodiscordant couples for an antiretroviral- based HIV-1 prevention intervention. BMC Infect. Dis. 2016;16(1):571. doi: 10.1186/s12879-016-1899-y
38. Baeten JM, Heffron R, Kidoguchi L, Mugo NR, Katabira E, Bukusi EA, et al. Integrated delivery of antiretroviral treatment and pre-exposure prophylaxis to HIV1- serodiscordant couples: A prospective implementation study in Kenya and Uganda. PLoS Med. 2016;13(8):e1002099. doi: 10.1371/journal.pmed.1002099