Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 8  |  Issue : 3  |  Page : 326-327  

Discordant HIV infection among married Indian couples


Department of Pediatric HIV, B. J. Wadia Hospital for Children, Parel, Mumbai - 400 012, Maharashtra, India

Date of Web Publication15-May-2015

Correspondence Address:
Ira Shah
240 D Walkeshwar Road, Malabar Hill, Mumbai - 400 006, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-2870.157076

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  Abstract 

Aim: The aim was to determine the incidence of discordant HIV infection in pregnant women and their husbands in late 1990s. Study Design: Retrospective analysis. Settings: Pediatric and perinatal HIV clinic from 1993 to 2000. Materials and Methods: All husbands of 729 HIV-infected pregnant women were tested for HIV. A husband was determined to be HIV negative if he had a negative HIV ELISA test at baseline and also 6 months later. Incidence of discordant couples was determined and analyzed to see whether there was an increasing trend of discordance over a period of years. Results: Forty-nine husbands (6.7%) were HIV negative. The probable causes of HIV in the lady were unknown in 38 couples (78%), through blood transfusion in 8 women (16%) and artificial insemination, surgery and 2 nd marriage in one woman each (2%). Incidence of discordance among the couples did not show an increasing trend (P = 0.34). Conclusion: Incidence of discordance among couples with HIV positive women and HIV negative husband did not show an increasing trend over a period of years, which may indirectly reflect the extra-marital situation.

Keywords: Couples, discordance, HIV


How to cite this article:
Shah I. Discordant HIV infection among married Indian couples. Med J DY Patil Univ 2015;8:326-7

How to cite this URL:
Shah I. Discordant HIV infection among married Indian couples. Med J DY Patil Univ [serial online] 2015 [cited 2020 Jun 1];8:326-7. Available from: http://www.mjdrdypu.org/text.asp?2015/8/3/326/157076


  Introduction Top


Unlike commercial sex workers, and patients with sexually transmitted diseases HIV infection among married couples is not a typical targeted risk factor. [1] Also, men are twice as likely as women to bring HIV infection into a marriage, presumably through extra-marital sexual behavior. [2],[3] Women become infected twice as fast as men probably due to increased biological susceptibility. [2] Prevalence of HIV in pregnant women has increased steadily, and sex with husbands is the only identified risk exposure for most of these women. [4] However, among married adults, the incidence of the serodiscordance with woman being HIV positive and the husband being negative has been reported ranging from 1.2% to 3.5% [2],[3] in Africa. However, serodiscordance among married, pregnant women who are HIV-infected and their husbands has never been studied earlier in India. We undertook this study to determine the prevalence of the serodiscordance among pregnant married HIV infected women and their husbands and also to analyze whether this discordance showed an increasing trend over in the late nineties.


  Materials and Methods Top


This study was undertaken to determine the incidence of HIV infection among married women where husband remained HIV uninfected. A retrospective analysis of 729 HIV infected pregnant women, and infant pair who were referred to our Pediatric and Perinatal HIV clinic from 1993 to 2000 was done. Pregnant women came to the antenatal clinic and were counseled regarding HIV testing. They were diagnosed to be HIV positive on the basis of 2 positive ELISA tests. The kits used for detection of HIV were DETECT-MC and HIV CHEK test. After the ELISA test, they were given posttest counseling. Husbands of women who were HIV were infected were tested for HIV and those who had a negative HIV ELISA test were retested after 6 months of the first test to rule out a negative test due to window period. Husbands who had a negative HIV ELISA test both at baseline as well as 6 months later were diagnosed to be HIV uninfected. All patients in whom there was discordance where either partner was positive, and the other negative by HIV ELISA had their HIV status confirmed by Western blot method.

All these couples were enrolled in the prevention of mother to child transmission of HIV (PMTCT) program at our center. Mothers received zidovudine 100 mg 5 times a day from 14 weeks of gestation onwards and underwent elective cesarean section at 38 weeks of gestation. Baby received zidovudine (2 mg/kg/dose 6 hourly) for 6 weeks and none of them were breast fed. All these infants were then followed-up till 18 months of age to determine their HIV status.

The incidence of discordant HIV infection in HIV infected pregnant women over this study period was determined and whether this incidence was increasing over a period of years was analyzed.

Statistical analysis

The statistical analysis was performed using Chi-square test.


  Results Top


Of 729, 49 husbands (6.7%) were HIV negative. The incidence of discordant couples period of years from 1993 to 2000 did not show an increasing trend (P = 0.34) [Table 1]. The causes of discordance were unknown in 38 couples (78%), through blood transfusion in 8 women (16%) and artificial insemination, surgery and 2 nd marriage in one woman each (2%).
Table 1: Incidence of discordant couples over period of 1993-2000

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  Discussion Top


Prevalence of serodiscordance among HIV infected pregnant women and HIV negative husbands was 6.7%, which is similar to that reported in Africa [2],[3] and less as that compared to Bangkok [4] where 26% of partners of HIV positive women where HIV negative. The causes of discordance were unknown in most of the couples and blood transfusion related HIV transmission in 16% of the couples in our study. As per the Bangkok collaborative study and also that from Africa, women reporting more than 1 life time sex partner were more likely to have an HIV-positive partner than women reporting only 1 partner. [4],[5] Since women in India live in a conservative society and having more than 1 sex partner is considered a taboo, disclosure of high risk sexual behavior is difficult to elicit from serodiscordant HIV infected women. Besides, fear of father not providing adequate care for the children in view of doubt of child's paternity can have implications on the care of the child and mother [6] and is another factor on nondisclosure. However, over a period of years, this prevalence of serodiscordance among pregnant married women has not shown an increasing trend in spite of more number of pregnant women being detected to be HIV infected, which is a point of relief. This may be due to awareness about AIDS, moral issues, avoiding sex before marriage and sex with only husband postmarriage. More and more awareness about AIDS should gradually lead to decrease of HIV infection among pregnant women and also of the serodiscordance among married couples.


  Conclusion Top


Serodiscordance among HIV infected pregnant married women and HIV negative husband is 6.7%. This serodiscordance has not shown an increasing trend over a period of years.

 
  References Top

1.
Mehendale SM, Ghate MV, Kishore Kumar B, Sahay S, Gamble TR, Godbole SV, et al. Low HIV-1 incidence among married serodiscordant couples in Pune, India. J Acquir Immune Defic Syndr 2006;41:371-3.  Back to cited text no. 1
    
2.
Carpenter LM, Kamali A, Ruberantwari A, Malamba SS, Whitworth JA. Rates of HIV-1 transmission within marriage in rural Uganda in relation to the HIV sero-status of the partners. AIDS 1999;13:1083-9.  Back to cited text no. 2
    
3.
Hugonnet S, Mosha F, Todd J, Mugeye K, Klokke A, Ndeki L, et al. Incidence of HIV infection in stable sexual partnerships: A retrospective cohort study of 1802 couples in Mwanza Region, Tanzania. J Acquir Immune Defic Syndr 2002;30:73-80.  Back to cited text no. 3
    
4.
Siriwasin W, Shaffer N, Roongpisuthipong A, Bhiraleus P, Chinayon P, Wasi C, et al. HIV prevalence, risk, and partner serodiscordance among pregnant women in Bangkok. Bangkok Collaborative Perinatal HIV Transmission Study Group. JAMA 1998;280:49-54.  Back to cited text no. 4
    
5.
Serwadda D, Gray RH, Wawer MJ, Stallings RY, Sewankambo NK, Konde-Lule JK, et al. The social dynamics of HIV transmission as reflected through discordant couples in rural Uganda. AIDS 1995;9:745-50.  Back to cited text no. 5
    
6.
Adejuyigbe EA, Odebiyi AI. Parental HIV serodiscordance: Implications for the care of the HIV seropositive child in a resource-poor setting. AIDS Care 2006;18:537-43.  Back to cited text no. 6
    



 
 
    Tables

  [Table 1]


This article has been cited by
1 Increasing sero-discordancy among young HIV infected pregnant women from India: a likely pointer of changing transmission dynamics
Ritu Parchure,Shrinivas Darak,Vijaya Jori,Asha Hegde,Anoop Kumar Puri,Vinay Kulkarni,Raman Gangakhedkar
AIDS Care. 2019; : 1
[Pubmed] | [DOI]



 

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