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| COMMENTARY |
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| Year : 2015 | Volume
: 8
| Issue : 3 | Page : 328-329 |
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Discordant human immunodeficiency virus infection among pregnant women and their husbands: What to be concerned about?
Viroj Wiwanitkit
Public Health, Surin Rajabhat University, Surin, Thailand
| Date of Web Publication | 15-May-2015 |
Correspondence Address:
Viroj Wiwanitkit
Wiwanitkit House, Bangkhae, Bangkok-10160
Thailand
 Source of Support: None, Conflict of Interest: None  | Check |
How to cite this article:
Wiwanitkit V. Discordant human immunodeficiency virus infection among pregnant women and their husbands: What to be concerned about?. Med J DY Patil Univ 2015;8:328-9 |
Human immunodeficiency virus (HIV) infection is still a global public health issue. This infection can be transmitted by several modes including blood borne and sexual transmission. In the present day, HIV infection can be seen around the world in any age groups. The problem of sexual transmission results in uncontrollable HIV epidemic around the world. [1] Many couples around the world contact HIV infection. The HIV might be transmitted from husband to wife or vice versa. [1] Then, the infection can also further transmit to the child of the infected spouse. This worst case scenario makes HIV the most important sexually transmitted disease at present.
There are several attempts to control HIV. Of several methods, the screening test is usually mentioned. The prenuptial screening for HIV serology is widely used. If the HIV infection is diagnosed before marriage, the control of HIV will become easier. However, prenuptial screening is not feasible in all settings due to personal, logistic and ethical reasons. The screening for the spouse in postnuptial phase has similar limitations. The screening is usually performed when one spouse gets confirmed HIV infection. The screening for HIV serology in the other spouse can be useful for management of this partner. This is the usual practice worldwide. In the present report in Med J Dr. DY Patil Univ, a single center situation is reported. [2] An interesting observation is the rate of discordant HIV infection among pregnant women and their husbands.
This discordance is an interesting issue. There are many possible explanations for discordance. In fact, some wives might know that their husbands get HIV infection or have high risk. Those wives might practice abstinence. On the other hand, some husbands that know themselves that they have HIV infection might also practice abstinence. However, a more interesting situation is situations without previous known HIV serology status. The most basic consideration is on the laboratory diagnostic test. In fact, the seronegative in the wife of a husband with HIV seropositive might be due to laboratory error. The false negative result is possible. The simplest situation is the window period that results in the escape in detection by screening test. In a report by Palumbo et al., 1 of 203 seronegative "adults who have long-term heterosexual relationships with HIV-infected partners" was positive for HIV infection by polymerase chain reaction (PCR) test. [3] Palumbo et al., concluded "a negligible incidence of occult HIV infection as delineated by PCR in antibody negative heterosexual partners of HIV-infected individuals. [3]"
Nevertheless, it should be noted that there are some cases that have actually no HIV infection despite long-term contact with HIV-infected husbands. The "protective roles for cell-mediated immunity and mucosal IgA in HIV-seronegative individuals exposed to HIV" is mentioned by Mazzoli et al. [4] The explanation can be due to the underlying special genetic factors. Hoffman et al., noted that "persons who are homozygous for the delta32 polymorphism of the CCR5 chemokine receptor gene are highly protected against HIV-1 infection. [5]" Rohowsky-Kochan et al., also reported that "human leukocyte antigen polymorphism may confer a genetic risk or protection for HIV-1 infection in individuals of various ethnic backgrounds. [6]" For the cases with surprising protective activity against HIV infection, the study of genetic polymorphism will be useful.
| References | |  |
| 1. | Johnson AM, Laga M. Heterosexual transmission of HIV. AIDS 1988;2 Suppl 1:S49-56.  |
| 2. | Shah I. Discordant HIV infection among married Indian couples. Med J DY Patil Univ 2015;8:326-7.  |
| 3. | Palumbo P, Skurnick J, Lewis D, Eisenberg M PCR analysis of HIV-seronegative, heterosexual partners of HIV-infected individuals. J Acquir Immune Defic Syndr Hum Retrovirol 1995;10:436-40. |
| 4. | Mazzoli S, Trabattoni D, Lo Caputo S, Piconi S, Blé C, Meacci F, et al. HIV-specific mucosal and cellular immunity in HIV-seronegative partners of HIV-seropositive individuals. Nat Med 1997;3:1250-7. |
| 5. | Hoffman TL, MacGregor RR, Burger H, Mick R, Doms RW, Collman RG. CCR5 genotypes in sexually active couples discordant for human immunodeficiency virus type 1 infection status. J Infect Dis 1997;176:1093-6. |
| 6. | Rohowsky-Kochan C, Skurnick J, Molinaro D, Louria D. HLA antigens associated with susceptibility/resistance to HIV-1 infection. Hum Immunol 1998;59:802-15. |
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