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. 2013 Mar 1;62(3):339-47.
doi: 10.1097/QAI.0b013e31827e622d.

An empiric risk scoring tool for identifying high-risk heterosexual HIV-1-serodiscordant couples for targeted HIV-1 prevention

Erin M Kahle  1 , James P Hughes, Jairam R Lingappa, Grace John-Stewart, Connie Celum, Edith Nakku-Joloba, Stella Njuguna, Nelly Mugo, Elizabeth Bukusi, Rachel Manongi, Jared M Baeten; Partners in Prevention HSVHIV Transmission Study and the Partners PrEP Study Teams
Collaborators, Affiliations

An empiric risk scoring tool for identifying high-risk heterosexual HIV-1-serodiscordant couples for targeted HIV-1 prevention

Erin M Kahle et al. J Acquir Immune Defic Syndr. .

Abstract

Background and objectives: Heterosexual HIV-1-serodiscordant couples are increasingly recognized as an important source of new HIV-1 infections in sub-Saharan Africa. A simple risk assessment tool could be useful for identifying couples at highest risk for HIV-1 transmission.

Methods: Using data from 3 prospective studies of HIV-1-serodiscordant couples from 7 African countries and standard methods for development of clinical prediction rules, the authors derived and validated a risk scoring tool developed from multivariate modeling and composed of key predictors for HIV-1 risk that could be measured in standard research and clinical settings.

Results: The final risk score included age of the HIV-1-uninfected partner, married and/or cohabiting partnership, number of children, unprotected sex, uncircumcised male HIV-1-uninfected partner, and plasma HIV-1 RNA in the HIV-1-infected partner. The maximum risk score was 12, scores ≥5 were associated with an annual HIV-1 incidence of >3%, and couples with a score ≥6 accounted for only 28% of the population but 67% of HIV-1 transmissions. The area under the curve for predictive ability of the score was 0.74 (95% confidence interval: 0.70 to 0.78). Internal and external validation showed similar predictive ability of the risk score, even when plasma viral load was excluded from the risk score.

Conclusions: A discrete combination of clinical and behavioral characteristics defines highest risk HIV-1-serodiscordant couples. Discriminating highest risk couples for HIV-1 prevention programs and clinical trials using a validated risk score could improve research efficiency and maximize the impact of prevention strategies for reducing HIV-1 transmission.

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Conflict of interest statement

Conflict of Interest: None of the authors have commercial or other conflicts of interest related to the content of this manuscript.

Figures

Figure 1
Figure 1
Incidence of HIV-1 infection by risk score
Figure 1
Figure 1
Incidence of HIV-1 infection by risk score
Figure 2
Figure 2
ROC curves comparing risk score to individual continuous predictors.
Figure 3
Figure 3
HIV-1 acquisition risk score worksheet.
See this image and copyright information in PMC

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