Elevated levels of inflammatory plasma biomarkers are associated with risk of HIV infection

BACKGROUND

To determine if individuals, from HIV-1 serodiscordant couple cohorts from Rwanda and Zambia, who become HIV-positive have a distinct inflammatory biomarker profile compared to individuals who remain HIV-negative, we compared levels of biomarkers in plasma of HIV-negative individuals who either seroconverted (pre-infection) and became HIV-positive or remained HIV-negative (uninfected).

RESULTS

We observed that individuals in the combined cohort, as well as those in the individual country cohorts, who later became HIV-1 infected had significantly higher baseline levels of multiple inflammatory cytokines/chemokines compared to individuals who remained HIV-negative. Genital inflammation/ulceration or schistosome infections were not associated with this elevated profile. Defined levels of ITAC and IL-7 were significant predictors of later HIV acquisition in ROC predictive analyses, whereas the classical Th1 and Th2 inflammatory cytokines such as IL-12 and interferon-γ or IL-4, IL-5 and Il-13 were not.

CONCLUSIONS

Overall, the data show a significant association between increased plasma biomarkers linked to inflammation and immune activation and HIV acquisition and suggests that pre-existing conditions that increase systemic biomarkers represent a factor for increased risk of HIV infection.

How reliable and valid are the self-reports of sexual behavior among HIV discordant couples in Pune, INDIA

Reliability of self-reported sexual and safe sex behavior among heterosexual HIV discordant couples was assessed by matching individual responses of couples to a common set of questions and validated by matching with pregnancy and seroconversion during study period. Demographic, clinical and sexual behavior information was collected individually from 457 consenting married discordant couples using structured questionnaires at screening, enrollment and at four quarterly visits. Reliability of self-reports tested using Kappa statistics. At screening, level of agreement about spouse being regular partner (Kappa = 0.96) and having had sexual intercourse with spouse in the last quarter (Kappa = 0.84) was noted. Moderate agreement observed about frequency of condom use (Kappa = 0.639) and condom tear (Kappa = 0.428). Agreement on reporting sexual contacts with spouse and consistent condom use increased (P < 0.001) over follow-ups. Four of 6 couples that seroconverted reported using condoms consistently, and 2 of these seroconverted. Couple histories of all 11 sero-discordant couples reporting pregnancy matched, of these 8 couples reported use of condoms and only 3 couples reported non-use of condoms during the preceding period. Sensitive sexual information can be collected using self-reports but it should be used with caution. Involving couples and using biological parameters concurrently may enhance validity of self-reports.

Use of a counsellor supported disclosure model to improve the uptake of couple HIV testing and counselling in Kenya: a quasi-experimental study

Background

Heterosexual couples account for 44% of new HIV infections in Kenya and there’s low awareness of self and partner HIV status. Different strategies have been employed to promote couple HIV testing and counselling (CHTC). Despite this, HIV incidence among couples continues to rise. This study sought to assess the use of a counsellor-supported disclosure (CSD) model in enhancing the uptake of CHTC and the factors that were associated with it.

Methods

A pre-post quasi experimental study design with an intervention and a comparison arm was utilized. The study was conducted in Nairobi, Nakuru, Kisumu, and Homa Bay counties in Kenya. A total of 276 participants were recruited; 149 and 127 in the comparison and intervention arms, respectively. Standard HIV testing & counselling (HTC) was offered in the comparison arm whereas the counsellor-supported disclosure model was administered in the intervention arm. The model empowered index clients to invite their sexual partner for CHTC. Telephone follow-up and subsequent community health volunteer (CHV) follow-up for non-responders were embedded in the model. Semi-structured questionnaires were used to collect data at baseline and 3 months into the study. In-depth interviews were conducted with 15 participants who took up the intervention and 7 of the HTC providers who offered CSD. The quantitative and qualitative data were analyzed using STATA version 13 and NVIVO 10, respectively.

Results

Uptake of CHTC was 28% in the intervention arm of the study compared to 7% in the comparison arm (p < 0.001). Participants in the intervention arm of the study had eight times higher odds of taking up CHTC compared to their counterparts. The outcome of the qualitative interviews revealed that the CSD counselling, skills on partner invitation, and follow-up for partner invitation increased the uptake of CHTC. On the other hand, unwillingness to test together with partner, lack of availability to test together as a couple, and provision of the wrong contact information by the participants reduced the uptake of CHTC.

Conclusion

The CSD model improved the uptake of CHTC. This model can be integrated into the existing HTC structures to enhance the uptake of CHTC.

Hormonal Contraceptive Use Among HIV-Positive Women and HIV Transmission Risk to Male Partners, Zambia, 1994-2012

BACKGROUND

Evidence on the association between female-to-male human immunodeficiency virus (HIV) transmission risk and hormonal contraception is sparse and conflicting.

METHODS

Heterosexual HIV-discordant couples from Lusaka, Zambia, were followed longitudinally at 3 month-intervals from 1994 to 2012. The impact of hormonal contraception on time to HIV transmission from HIV-positive women to their HIV-negative male partners (M-F+) was evaluated.

RESULTS

Among 1601 M-F+ couples, 171 genetically linked HIV transmissions occurred in men over 3216 couple-years (5.3 transmissions/100 couple-years; 95% confidence interval [CI], 4.5-6.2). In multivariable Cox models, neither injectable (adjusted hazard ratio [aHR], 0.6; 95% CI, .4-1.2), oral contraceptive pill (aHR, 0.8; 95% CI, .3-2.1), nor implant (aHR, 0.8; 95% CI, .5-1.4) use was associated with HIV transmission, relative to nonhormonal methods, after controlling for the man's age at baseline and time-varying measures of pregnancy, self-reported unprotected sex with the study partner, sperm present on a vaginal swab wet mount, genital inflammation of either partner, genital ulceration of the man, and first follow-up interval. Sensitivity analyses, including marginal structural modeling and controlling for viral load and fertility intentions available in a subset of couples, led to similar conclusions.

CONCLUSIONS

Our findings suggest null associations between hormonal contraception and risk of female-to-male HIV transmission. We support efforts to increase the contraceptive method mix for all women, regardless of HIV serostatus, along with reinforced condom counseling for HIV-serodiscordant couples.