Cohort Study Of HIV/AIDS Among Seronegative Couples Of HIV Infected Individuals

1. Sero-incidence and Correlates of Human immunodeficiency virus among HIV Sero-discordant Couples in Dehong Prefecture, Yunnan ProvinceObjective:To determine the sero-incidence of Human immunodeficiency virus (HIV) and correlates among HIV sero-discordant couples in Dehong prefecture, Yunnan province and provide the basis for the prevention and control of HIV infection in China.Methods:A prospective cohort of sero-negative spouses of HIV patients has been developed and followed up from5counties of Dehong prefecture, Yunnan province since June,2009. HIV new infections were determined and social-demographic, related behavioral characteristics have been collected every six months. The cohort data of sero-negative spouses of HIV patients has been paired and merged with a cohort of HIV infectors which was conducted during the same period for obtaining HIV infectors’HIV status and information of ART. According to the latest follow-up, HIV sero-incidence was acquired and predictors of incident infection were examined using Cox proportional hazards model.Results:(1)By the end of October,2011,1227sero-negative spouses of HIV patients had been recruited, of whom1058were followed-up at least once,138lost. There was no significant difference of age, marriage, education, occupation between subjects followed up and lost. But the propations of gender, ethnic, recent residencewere significantly different between lost and followed.(2)A total of1058sero-negative spouses of HIV patients were included into Statistical analysis,990HIV infectors were merged with these sero-negative spouses. During the total of1355.37person-years,19new HIV infections were identified, with an overall incidence of1.40/100person-years. The HIV incidence was1.88/100person-years among males,1.28/100person-years among females. Cox proportional hazard regression model indicated that among sero-negative spouses, males(HR=3.06,95%CI:1.05-8.97, P=0.041); inconsistent condom use(HR=6.89,95%CI:2.24-21.17, P=0.001)、ever had Temporary sex (HR=11.06,95%CI:2.30-53.19, P=0.003); genital organ abnormalities (HR=3.74,95%CI:1.05-13.33P=0.042); Among the paired HIV infectors, ever had injection drug use(HR=3.76,95%CI:1.02-13.90, P=0.047); never had ART(HR=1.18,95%CI:1.04-1.34, P=0.011)、HIV viral load>10000IU/mL(HR=13.53,95%CI:1.67-109.50, P=0.015)、CD4+T cell count351-550cells/mL(HR=5.23,95%CI:1.15-23.72, P=0.032)、baseline HCV anti-body"+"(HR=4.25,95%CI:1.23-14.65, P=0.022) were at higher risk for HIV new infection among sero-negative spouses.Conclusions:In this study, sero-negative spouses of HIV patients in Dehong prefecture of Yunnan province had a relatively lower incidence of HIV new infection than those during the2006-2008period. The possible causes of the decline might be the relative with the widely condom use and making knowledge of hygiene much more available in these years. HIV infectors’HIV status, ever had ART, consistent condom use and other STDs are significantly correlated with sero-negative spouses’ HIV new infection. More efforts are needed for HIV prevention and intervention among couples those who having a history of high-risk related behavior or having an HIV-infected spouse never exposed to antiretroviral treatment. 2. A Nested Case Control Study of HIV-1new infection and Cytokine levels between HIV-sero-positive couples and Highly exposed but persistently seronegative(HEPS)Objective:Based on the nested case control study, to explore the potential HIV-1susceptibilities in epidemiological information. To investigate the differences of Plasma cytokines levels between HIV-seropositive couples and Highly exposed but persistently sero-negative(HEPS), and the changes of Plasma cytokines levels for HIV-seropositive couples prior to and after turning HIV-seropositive for exploring the HIV susceptibilities in cytokine level.Methods:A nested case control study had been designed. By the end of October,2011, select19HIV sero-positive couples of HIV patients as cases,145HEPS as controls. Compute HIV sero-positive rate and evaluate the relative determinants by Logistic univariate and multivariate analysis. Plasma concentrations of the cytokines, IL-2, IL-4, IL-5,IL-6, IL-7, IL-10, IL-12(p40), IL-12(p70), IL-15, IL-17, tumor necrosis factor(TNF)-a and interferon (IFN)-y, GM-CSF and IFN-a2were measured on the Luminex200platform by using Millipore’s Milliplex Human Cytokine/Chemokine Kit, according to the manufacturer’s recommendations. Mann-Whitney U test was used for between-group comparisons. Paired differences between two groups were tested by using Wilcoxon signed-rank test. Spearman rank correlation test was used to assess the correlation among the changes in the levels of cytokines and CD4+T cell numbers.Conclusions:(1) This part recurited164couples(includes19HIV-sero-positive couples and145HEPS), male22.0%(36/164), age33.74±8.41岁; Dai ethnicity41.5%, Jingpo ethnicity31.7%; Illiterate and elementary72.6%. The paired HIV infectors ever had ART43.9%(72/164)。 Case group and control group are significantly different between the proportions of ethnicity (X2=11.157,P=0.011)、current rescidence (X2=9.519,P=0.049), condom use (x2=7.126, P=0.028、HIV viral load (x2=5.924, P=0.050)、genital organ abnormalities (x2=3.857, P=0.050). The average detection rate of9cytokines was76.7%, TNF a was the highest99.4%(182/183), IL-6was the lowest58.5%(107/183).(2)Logistic multivariate analysis indicated that genital organ abnormalities (OR:68.21,95%CI:3.42-100.05, P=0.006); low-frequency condom use (OR:7.63,95%CI:1.12-276.32, P=0.041); HIV infectors’HIV viral load>10000IU/mL (OR:25.68,95%CI:1.17-562.33, P=0.039);CD4+T cell count0-200cells/μL(OR:30.39,95%CI:1.24-746.10, P=0.037), while HIV infectors’ ART status was not meaningful.(3) The baseline IL-4(Median:3.20pg/mL, IQR:1.57-5.53pg/mL), IL-17(Median:1.09pg/mL, IQR:0.83-1.24pg/mL)and IFN-γ(Median:2.01pg/mL, IQR:1.08-3.40pg/mL) of Case group is significantly higher than those of control group (Median:1.24pg/mL,IQR:0.55-3.53pg/mL)、IL-17(Median:0.45pg/mL, IQR:0.15-1.18pg/mL)and IFN-γ(Median:0.69pg/mL, IQR:0.15-1.73pg/mL).(4)The differences of IL-6and TNF α between prior to and after turning HIV-seropositive are significantly different.(5) The positive correlations among cytokines of HEPS is more active than those of HIV new infections at baseline; The distribution of positive correlations among different cytokines of HIV new infections between baseline and HIV turning point is quite different.Conclusions:The baseline IL-4、IFN-γ of case group is significant higer than those of control group indicated that the baseline levels of cellular immune system had occurred some certain cellular anergy state or stimulation state which makes a protective role in maintaining the balance between Thl-Th2and make individuals not be infected by HIV. The baseline IL-17of case group is significant higer than those of control group indicated that the cellular immune response might be active to HIV infection. The levels of IL-6and TNF-a at the point of HIV-seropositive are higher than those of baseline among case group, which indicated that the positive induction and interaction between HIV-infection and IL-6, TNF-a might exist. The positive correlations among cytokines of HEPS is more active than those of HIV new infections at baseline; The distribution of positive correlations among different cytokines of HIV new infections between baseline and HIV turning point is quite different.