Clinical and pathological characteristics of HIV discordant couples at Kenyatta National Hospital

Abstract

Background:HIV discordance is common in African couples .Despite knowledge on the population dynamics,epidemiology and transmission of HIV in stable couples, we do not have data on their clinical, pathological and sexual characteristics in discordant couples. Objectives: To determine the clinical, pathological and sexual characteristics of HIV-1 discordant couples and compare factors that influence HIV -1 transmission in male and female discordant couples attending PSC at the Kenyatta national hospital. Design: Cross-sectional descriptive study. Setting: PATIENT SUPPORT CENTER (PSC) at KNH Study population: Adults (over18 years) HIV-l sero-discordant couples. Methodology: 96 discordant couples referred to the Patient Support Center were recruited in the study. HIV test by rapid test method for couples more than a week since referral date to the PSC and for those without copies of HIV -1 results. Only those who gave a written consent and fulfilled the inclusion criteria were recruited. History and physical examination was undertaken on each participating partner .The WHO clinical stage of HIV disease was established in the positive partner. Urine specimens, pus swabs from bases of ulcerative and exudative genital ulcers in both partners; urethral discharge specimen in male and a high vaginal smear in female cases were collected for microbiology analysis. Seven milliliter sample of venous blood was drawn aseptically from antecubital vein for CD4 lymphocyte count and HIV -1 VIRAL LOAD of the sero-positive partner in the HIV -1discordant relationship. Data Analysis: Data was analyzed using SPSS/PC + VERSION 12 programme. Descriptive statistics for continuous and categorical data were done from which measures of central tendency and proportion were derived. Using univariate logistic model with each partner discordance status as the dependent variable and CD4,VIRAL LOAD, frequency of sexual intercourse, duration of marriage and STI as independant variables ,comparison were made on variables that alter HIV -1 transmission dynamics in a discordant relationship in male and female positive partners. Results:96 couples were analyzed in the study. Of this, 69 female(72%) and 27 male(28%) were HIV positive giving a female to male ratio of2.6:l.The median age of the all male participants was 34 years while for the female partners was 26 years.Eighty nine percent of positive partners were in early WHO clinical stages 1 and 2. The mean viral load in the positive partners was 11447 copies per ml with a median of 4505 copies per milliliter. The mean CD4 cell count was 446 cell per microlitre in the positive partners ..Most couples engaged in protected marital sex post notification of their HIV status. The male positive partners had advanced disease based on a higher mean viralloads(20074 versus 9045 viral copies) and lower mean CD4 cell counts(407 versus 455 CD4 cells) than the female positive partners. Conclusion:There are more female positive partners in HIV discordant couples attending PSC clinic at the Kenyatta national hospital .Most partners present in early WHO clinical stage of disease with a low mean viral load and favourable CD4 count.The couples have a low STI prevalence. Other than duration of marriage and frequency of sexual intercourse, there are no gender differences in the transmission factors in male and female positive partners in discordant couples. Molecular characterization of these negative partners is required to assess further the factors preventing transmission of the virus. 4-'