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

Abstract

Background: Health 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.

Methods: This 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.

Results: A 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 < 0.001). Of 237 HIV-infected partners, 17.7% had AIDS-defining illness, the median nadir CD4 count (interquartile range) was 240 (96-427) cells/mm3, 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).

Conclusions: A 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.

Fig 1. Study flowchart.

^aadherence, adverse drug reaction, CD4 count, and HIV RNA; ^badherence < 95%, had adverse drug reaction, or detectable HIV RNA (> 200 copies/mL) in the prior 6 months; ^cHIV prevention and adherence counselling; repeated HIV RNA and/or HIV genotype (if HIV RNA > 1,000 copies/mL).

Fig 2. Proportion of couples using condoms or abstaining from sex, stratified by the HIV serostatus of the partners.

Fig 3. Proportion receiving antiretroviral therapy and outcomes of the index HIV-infected patients with serodiscordant, seroconcordant, and unknown HIV serostatus partners.