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Pregnancy and HIV transmission among HIV discordant couples in a clinical trial in Kisumu, Kenya
Presented by Sara Brubaker (United States).
S. Brubaker1, E.A. Bukusi2, J. Odoyo3, J. Achando3, A. Okumu3, C. Cohen1
1University of California San Francisco (UCSF), Obstetrics, Gynecology and Reproductive Sciences, San Francisco, United States, 2Kenya Medical Research Institute (KEMRI), Center for Microbiology Research, Nairobi, Kenya, 3Kenya Medical Research Institute (KEMRI), Center for Microbiology Research, Kisumu, Kenya
Background: Recent data suggest that a large proportion of new HIV infections in sub-Saharan Africa occur in stable HIV discordant partnerships. In some couples, the strong desire to get pregnant may lead to risky behavior despite knowledge of discordant serostatus, resulting in ongoing HIV transmission in this population.
Methods: A total of 539 HIV discordant couples were followed for up to two years in Kisumu, Kenya as part of the Partners in Prevention HSV/HIV Transmission Study. Participant HIV results, urine pregnancy test results, and demographic information were extracted from the database and used to compare couples who did and did not become pregnant.
Results: A total of 41 HIV seroconversions occurred over 888 person-years of follow-up resulting in an annual incidence of 4.6/100 person-years. One hundred and eighty-nine (35.1%) women got pregnant; 106 (32.5%) index (HIV-infected) women, and 83 (39.3%) partners (HIV-uninfected women) (p = 0.11). Twenty (10.8%) HIV transmission events occurred among 186 HIV-uninfected individuals in couples in which the female partner conceived compared to 21 (5.9%) HIV transmission events among 353 HIV-uninfected individuals in couples in which the female partner did not conceive (RR = 1.8, 95% CI 1.01-3.25, p < 0.05). Of the 20 seroconversions that occurred in couples who became pregnant 65% occurred within 6 months prior to conception and during the first 6 months of pregnancy and the remaining 35% occurred more than 6 months from conception.
Conclusions: Pregnancy was common among HIV discordant couples and was associated with an increased risk of HIV seroconversion. Although not conclusive, these data suggest that the intention to conceive among HIV discordant couples may be contributing to the epidemic. Interventions that reduce the risk of HIV sexual transmission while allowing conception may play an important role in HIV prevention efforts in sub-Saharan Africa.
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