Prevalence of HIV infection, access to HIV care, and response to antiretroviral therapy among partners of HIV-infected individuals in Thailand

BackgroundHealth care providers usually focus on index HIV-infected patients and seldom obtain information from their partners. We aimed to determine HIV-preventative measures among couples, the prevalence of HIV infection, and treatment outcomes of partners.MethodsThis cross-sectional study was conducted in two hospital settings, a university hospital in Bangkok and a general hospital in northeastern Thailand, from January 2011-October 2015. Factors associated with serodiscordant relationships were determined by logistic regression.ResultsA total of 393 couples were enrolled for analysis; 156 (39.7%) were serodiscordant. The median relationship duration of serodiscordant couples was shorter than that of seroconcordant couples (6.4 years vs 11.6 years, p 3, 83.5% received antiretroviral therapy (ART), 98.3% had adherence > 95%, 90.3% had undetectable HIV RNA, and 22.9% had a prior history of treatment failure. There was no significant difference in condom usage in the prior 30 days between serodiscordant and seroconcordant couples. Factors of index HIV-infected patients associated with serodiscordant relationships were younger age (odds ratio [OR] 1.04 per 5 years; 95% confidence interval [CI] 1.01–1.06), receiving care at the general hospital (OR 1.73; 95% CI 1.08–2.78), a shorter duration of relationship (OR 1.04 per year; 95% CI 1.01–1.07), a higher nadir CD4 count (OR 1.06 per 50 cells/mm3; 95% CI 1.1–1.13), and not receiving a protease inhibitor-based regimen (OR 2.04; 95% CI 1.06–3.96).ConclusionsA high number of serodiscordant couples was determined. Partners’ information should be retrieved as a holistic approach. Interventions for minimizing HIV transmission within serodiscordant couples should be evaluated and implemented.

背景：医护人员通常仅关注人类免疫缺陷病毒（HIV，Human Immunodeficiency Virus）感染者先证病例，极少获取其性伴侣的相关信息。本研究旨在探究夫妇间的HIV预防措施、HIV感染流行率以及性伴侣的治疗结局。
方法：本研究为横断面研究，于2011年1月至2015年10月期间在泰国两家医院开展，分别为曼谷的一所大学附属医院，以及泰国东北部的一所综合医院。采用logistic回归（logistic regression）分析与血清学不一致（serodiscordant）伴侣关系相关的影响因素。
结果：共计393对夫妇纳入分析，其中156对（39.7%）为血清学不一致伴侣关系。血清学不一致夫妇的中位伴侣关系时长短于血清学一致（seroconcordant）夫妇（6.4年 vs 11.6年，p<0.001）；83.5%的研究对象接受了抗反转录病毒治疗（antiretroviral therapy, ART），98.3%的治疗依从性＞95%，90.3%的HIV RNA检测不到，22.9%曾出现治疗失败。血清学不一致与血清学一致夫妇在过去30天的安全套使用情况无显著差异。与血清学不一致伴侣关系相关的HIV感染者先证病例特征包括：年龄更轻（比值比[OR, odds ratio]为1.04/每5年；95%置信区间[CI, confidence interval]：1.01~1.06）、在综合医院接受诊疗（OR=1.73；95%CI：1.08~2.78）、伴侣关系时长更短（OR=1.04/每1年；95%CI：1.01~1.07）、CD4细胞最低计数（nadir CD4 count）更高（OR=1.06/每50个细胞/mm³；95%CI：1.01~1.13）、未接受基于蛋白酶抑制剂（protease inhibitor）的治疗方案（OR=2.04；95%CI：1.06~3.96）。
结论：本研究发现血清学不一致夫妇占比颇高。临床实践中应采用整体化策略获取性伴侣的相关信息。需评估并实施旨在降低血清学不一致夫妇间HIV传播风险的干预措施。