2009 IAS

5th IAS Conference on HIV Pathogenesis, Treatment and Prevention

Pregnancy and HIV transmission among HIV discordant couples in a clinical trial in 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.

Rapid HIV testing in a U.S. Emergency Department: using fever as an indicator for testing

Background: The Centers for Disease Control and Prevention (CDC) recommends expanding routine HIV testing to all healthcare centers including emergency departments (ED). Early ED programs report seroprevalence rates ~1% using rapid testing. We sought to assess approaches that may improve test acceptance and enrich detection rates in a U.S. university hospital ED.
Methods: Based on earlier work, we hypothesized that fever may serve as an objective marker of populations at higher risk for HIV. In December, 2008, we initiated HIV screening using a free rapid oral swab HIV test done at the bedside in non-urgent adult ED patients capable of providing informed consent who were not previously diagnosed with HIV. Rates of diagnosis among febrile (>38°C) and afebrile patients will be compared. Patients declining testing are asked to complete a questionnaire identifying reasons for refusal.
Results: Through 2/17/09, 145/224 (65%) of patients have agreed to be tested; reasons for refusal included being ‘recently tested’, ‘not feeling well’, and perceived as not at risk. Demographics of the tested population are representative of those seeking care in the ED: median age 40.4 years; African-American 60%, white 35%; male 41%. Only 23 patients (10%) have been febrile. Thus far, there has been 1 confirmed new HIV diagnosis (in a patient who was febrile) and 2 false positive test results.
Conclusions: Using fever as an indicator condition for HIV testing avoids concerns about stigmatization and provider bias, and may improve yield of rapid HIV testing programs in the ED setting, facilitating better testing resource allocation. This approach appears to be well-accepted and accesses a population fully representative of overall ED patients. Additional data from a larger sample will help determine the full value of this approach.

Last modified: November 2, 2012