北部ベトナムのHIVに感染した夫婦におけるHIVの血清学的不一致率は高い

Introduction: Little is known about the state of HIV transmission among married couples in Vietnam. This study aims to clarify HIV serostatus in this group and elucidate risk factors for intra-marital HIV transmission. Methods: In 2012, we enrolled a group of HIV-positive married men registered at the HIV outpatient clinic of a referral hospital in northern Vietnam, along with their wives. Sociodemographic, behavioural and clinical data were collected from men and wives. HIV serodiscordant couples were followed until March 2014 to determine seroconversion rate. A phylogenetic analysis was performed based on env V3 sequence to detail cluster formation among men. Results: Of the 163 HIV-positive men enrolled in the study, 101 (62.0%) had wives testing HIV-negative. Half of men reported injecting drug use (IDU) as a likely transmission route. Couples reported a high incidence of unprotected sexual intercourse prior to diagnosis; the median (inter quartile range) was 4 (4?8) times per month. Only 17 couples (10.4%) reported using condoms during at least half these instances. Multivariable analysis revealed IDU history among men was independently associated with HIV-negative wives (adjusted OR 0.31; 95% CI 0.10?0.95, p=0.041). Phylogenetic analysis of 80 samples indicated CRF01_AE. Of these, 69 (86.3%) clustered with IDU-associated viruses from Vietnam. No HIV seroconversion was identified during a follow-up of 61 serodiscordant couples, with 126.5 person-years of observation during which HIV-infected men were on antiretroviral drug therapy (ART). Conclusion: High HIV serodiscordance was observed among HIV-affected married couples in northern Vietnam. A large number of at-risk wives therefore remain HIV-negative and can be protected with measures including proper use of ART if couples are made aware of the serodiscordance through screening.長崎大学学位論文 学位記番号:博(医歯薬)甲第896号 学位授与年月日:平成29年1月31日Author: Ikumi Sawada, Junko Tanuma, Cuong Duy Do, Tra Thu Doan, Quynh Phuong Luu, Lan Anh Thi Nguyen, Tuong Van Thi Vu, Tuan Quang Nguyen, Naho Tsuchiya, Teiichiro Shiino, Lay-Myint Yoshida, Thanh Thuy Thi Pham, Koya Ariyoshi, Shinichi OkaCitation: PLOS ONE, 10(4), e0125299; 2015Nagasaki University (長崎大学)課程博