Risk of heterosexual HIV transmission attributable to sexually transmitted infections and non-specific genital inflammation in Zambian discordant couples, 1994–2012. (11th April 2017)

• Record Type: Journal Article
• Authors: Wall, Kristin M; Kilembe, William; Vwalika, Bellington; Haddad, Lisa B; Hunter, Eric; Lakhi, Shabir; Chavuma, Roy; Htee Khu, Naw; Brill, Ilene; Vwalika, Cheswa; Mwananyanda, Lawrence; Chomba, Elwyn; Mulenga, Joseph; Tichacek, Amanda; Allen, Susan
• Is Part Of: International journal of epidemiology. Volume 46:Number 5(2017)
• Page Start: 1593
• Page End: 1606
• Publication Date: 2017-04-11
• Subjects: Couples' -- voluntary HIV counselling and testing -- discordant couples -- HIV risk -- genital ulceration and inflammation -- longitudinal cohort -- Zambia; Epidemiology -- Periodicals; 614.4
• DOI: 10.1093/ije/dyx045
• Languages: English
• ISSNs: 0300-5771

Abstract

Abstract: Background: Studies have demonstrated the role of ulcerative and non-ulcerative sexually transmitted infections (STI) in HIV transmission/acquisition risk; less is understood about the role of non-specific inflammatory genital abnormalities. Methods: HIV-discordant heterosexual Zambian couples were enrolled into longitudinal follow-up (1994–2012). Multivariable models estimated the effect of genital ulcers and inflammation in both partners on time-to-HIV transmission within the couple. Population-attributable fractions (PAFs) were calculated. Results: A total of 207 linked infections in women occurred over 2756 couple-years (7.5/100 CY) and 171 in men over 3216 CY (5.3/100 CY). Incident HIV among women was associated with a woman's non-STI genital inflammation (adjusted hazard ratio (aHR) = 1.55; PAF = 8%), bilateral inguinal adenopathy (BIA; aHR = 2.33; PAF = 8%), genital ulceration (aHR = 2.08; PAF = 7%) and the man's STI genital inflammation (aHR = 3.33; PAF = 5%), BIA (aHR = 3.35; PAF = 33%) and genital ulceration (aHR = 1.49; PAF = 9%). Infection among men was associated with a man's BIA (aHR = 4.11; PAF = 22%) and genital ulceration (aHR = 3.44; PAF = 15%) as well as with the woman's non-STI genital inflammation (aHR = 1.92; PAF = 13%) and BIA (aHR = 2.76; PAF = 14%). In HIV-M+F- couples, the man being uncircumcised. with foreskin smegma. was associated with the woman's seroconversion (aHR = 3.16) relative to being circumcised. In F+M- couples, uncircumcised men with BIA had an increased hazard of seroconversion (aHR = 13.03 with smegma and 4.95 without) relative to being circumcised. Self-reporting of symptoms was low for ulcerative and non-ulcerative STIs. Conclusions: Our findings confirm the role of STIs and highlight the contribution of non-specific genital inflammation to both male-to-female and female-to-male HIV transmission/acquisition risk. Studies are needed to characterize pathogenesis of non-specific inflammation including inguinal adenopathy. A better understanding of genital practices could inform interventions.