(4)
ABSTRACT
Thestudywascarriedouttoassessthe
clinicoepidemiologicalfactorsthatarelikelyto
influenceHIVtransmissionamongmarriedcouples.
105HIVpositivefemalesattendingSkin-VD
DepartmentofMedicalCollege,Barodawere
enrolledandtheirspousesweretestedforHIV.
Variousfactorslikemodeoftransmission,
circumcision,sexuallytranmsittedinfectionswere
studied.Outof105couples,76were
seroconcordantand29wereserodiscordant.Use
ofcondomwasdonein20.7percentcouplesof
seroconcordantgroupandinonly6.6percent
couplesofserodiscordantgroup.Spousal
transmissionwasmoreincasesaquiringHIVvia
sexualroutethanthoseacquiringbyblood
transmission.STD'sweresignificantlyhighinthe
seroconcordantgroup(P=0.008;CI95percent)
ascomparedtotheserodiscordantgroup.
Circumcisionwassignificantlyhighinthe
seroconcordantgroup(P<0.001;CI=95percent)
ascomparedtoseroconcordantgroup.Sothese
factorsplayanimportantroleininfluencingHIV
transmissionamongmarriedcouples.The
consistentuseofcondomscoupledwithearly
diagnosisandtreatmentofSTD'scansignificantly
reduceriskofHIVtransmission.
KEYWORDS
Seroconcordance,Serodicordance
INTRODUCTION
ThoughalotisknownaboutHIV,therearecertain
aspectswhichareyettobeunderstood.Thefactors
responsibleforserodicordance(i.e.HIVpositivity
inonlyonepartner)andnon-transmissionofHIV
arepoorlystudiedandneedtobeclearly
established.HIVnegativeindividualsindiscordant
partnershipsareatahighriskofinfectionsand
preventiveinterventionstargetedatsuchindividuals
areurgentlyneeded.
ANEPIDEMIOLOGICALSTUDYOFHIVSEROCONCORDANT
VsSERODISCORDANTCOUPLES(AFEMALBASEDSTUDY)
SharmaArchana*,MarfatiaYS**
*PostGraduateStudent
**Professor,DepartmentSkin-VD,GovernmentMedicalCollege,Baroda-390001
AddressforCorrespondence:
DrYSMarfatia,Professor&Head,DepartmentofSkin-VD,MedicalCollege,Baroda-390001
Emailym11256@yahoo.com
AIMSOFSTUDY
Tostudysomeofthefactorsthatarelikelyto
influenceHIVtransmissionamongmarriedcouples.
MATERIAL&METHODS
105HIVpositivefemales(testedbytwoELISA)
attendingSkin-VDDepartmentofMedicalCollege,
BarodafromMarch2002toFebruary2004were
enrolled.
TheirspousesweretestedforHIV.Variousfactors
likecondomuse,modeoftransmission.STI
circumcisionwerestudiedandtheirpossible
influenceonspousaltransmissionwasassessed.
RESULTS
TABLE-1
SPOUSESOFHIVPOSITIVEFEMALES(n=105)
HIVStatus No.ofMales Percentage
HIV+vemales 76 72.4
HIV-vemales 29 27.6
Total 105 100.0
76CoupleshadbothpartnersPositiveforHIVi.e.they
wereseroconcordantand29wereserodiscordanti.e.
onepartnerpositiveandtheothernegative.
TABLE-2
USEOFCONDOM&SEROCONCORDANCE
SERODICORDANCE
UseofCondom UseofCondom
Present% Absent%
S.D.(29) 6(20.7) 23(79.3)
S.C.(76) 5(6.6) 71(93.7)
Total 11 94
Althoughtheoverallacceptanceofbarrier
contracptivewaslow,theuseofcondomwas
significiantlyhighintheserodiscordantgroupas
comparedtoseroconcordantgroup.
INDIANJSEXTRANSMDIS2005;VOL.26NO.1,11
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TABLE-3
RELATIONSHIPBETWEENMODEOF
TRANSMISSION&SEROCONCORDANCE/
SERODISCORDANCE
 Mode of Mode of HIV Positive
Transmission Acuisition in Males (n=76)
(n = 105)
Sexual Transmission 64 5
Blood Transfusion 41 19
Outof105HIVpositivefemales,64acquiredHIV
throughsexualroute,eitherthroughhusband(57
husbandswerepositive)orthroughinfected
partners.41femalescontractedHIVthroughblood
transfusionand19probablypassedoninfectionto
theirhusbands.
SexualacuisitionofHIVmayreflecthighriskofat
leastonespouse.
TABLE-4
RELATIONSHIPBETWEENSEXUALLY
TRANSMITTEDDISEASES(STD)&
SEROCONCORDANCE/
SERODISCORDANCE
Female STD (+nt)% STD (-nt)%
S.C. (n=76) 40 (52.6) 36 (47.3)
S.D. (n=29) 07 (24.1) 22 (75.8)
Ttl4758
X2(ChiSquare)=6.89;P=0.0086(P<0.01is
significant).CI(Confidenceinterval)=95percent
Male STD (+nt)% STD (-nt)%
S.C. (n=76) 27 (35.5) 49 (64.4)
S.D. (n=29) 01 (3.4) 28  (96.5)
Ttl2877
X211.05;P=0.00088(P<0.001ishighlysignificant,
CI=85percent
52.6percentoffemalesand35.5percentofmales
intheseroconcordantgrouphadSTDswhichwas
significantlyhighascomparedtoSTDratein
serodiscordantgroup.
TABLE-5
RELATIONSHIPBETWEENCIRUMCISION
TRANSMISSION&SEROCONCORDANCE/
SERODISCORDANCE
Seroconcordant Serodiscordant
(n=76)% (n=29)%
Circumcision 05(6.5) 11(37.9) 16
Present
Circumcision 71(93.4) 18(62.0) 89
Absent
X2=15.92;P=0.000064(P<0.001ishighly
significant);CI=95percent
Circumcisioninmaleswasmoreprevalentinthe
serodiscordantgroupandseenin37.9percent
cases.Itwashighlysignificantascomparedtothe
seroconcordantgroup.Amanwhoiscircumcised
upto8timesislesslikelythantheonewhoisnotto
acquireHIVviaheterosexualroute1.Onepossible
explanationrelatestothelargenumberof
Langerhanscellsinpreputialskinwhichmaybe
infectedbyHIV1.
Circumcisionalsoreducesthelikelihoodof
contractingSTD,hence,decreasingchancesofHIV
transmission.
DISCUSSION
SeropositivityamongmalespousesofHIVpositive
femaleswasmorefrequentwhenHIVwasacquired
throughsexualroute.Condomusage,presenceof
STDsandcircumcisionhaveinfluenceovertheHIV
transmissionamongmarriedcouples.Ofthese
STDshavesignificantlyincreasedriskofHIV
transmissionamongcouples.
InastudyofRNGuptaetal,22percentoffemales
continuedhavingsexualintercoursewiththeir
husbandswithoutcondom,inspiteofknowingtheir
HIVstatus2.Usageofcondomislesswithspouse/
regularpartnerascomparedtosexworkersand
thisfacilitatesspousaltransmission.Itisallthemore
importantforseroconcordantcouplestouse
condomtopreventfurtherexposuretoHIVor
exposuretodifferentstrainsofHIV.
InastudydonebyLatifASetal,itwasreported
thatmenwhohaveahistoryofgenitalulcerdisease
weresignificantlymorelikelytohaveawifewho
wasseropositive3.STDsfacilitatetransmissionof
HIVnotonlyduetoinfiltrationandmucosalabrasion
INDIANJSEXTRANSMDIS2005;VOL.26NO.1,12
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butalsobyrecruitingmorenumberofCD4cellsat
thesiteofinfection4.
InanSTDclinicinNairobi,Kenya,presenceofmale
foreskinwassignificantlyassociatedwithSTD(2.5
foldrisk)andHIVinfection(4fold)increasedrisk5.
Lackofcircumcisionisassociatedwithpoorhygiene,
chancesoftraumaandmorechancesofSTDslike
chancroid,syphilis,genitalherpes,gonorrheaand
genitalwarts6.
Althoughitwasnotpossibleforustoelicithistoryof
sexualpracticesbutitisseenthatcertainsexual
practicesfollowedbythecouplesalsoinfluences
sexualtransmission7.
CONCLUSION
Protectivesexualpracticescancertainlypreventrisk
ofHIVtransmission.Moreover,earlydiagnosisand
treatmentofSTIscansignificantlyreducetherisk
ofHIVtransmission.Marriedcouplesinthis
populationshouldbeencouragedtoattendforHIV
counselingtogethersothatserodiscordancecan
beidentifiedandadvisedaccordingly.
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Gujarat.
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al.PsychosexualhealthandriskfactorsforHIV
amongmarriedIndianWomen.
www.retroconference.org/archive/posters/retro10/31.pdf.
3. LatifAS,KatzensteinDAetal.Genitalulcersand
transmissionofHIVamongcouplesinZimbabwe,AIDS
1989,519-23.
4. WasserheitJN,Epidemiologicalsynergy,Interrelationship
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SexuallyTransmittedDiseases.TextbookofSTDsand
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7. StenHVermund,PBTabereaux:EpidemiologyofHIV
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Merigan/Bartlett/Bolognesi(editors),2ndedition,
WilliamandWilkins,1999page101-109.
INDIANJSEXTRANSMDIS2005;VOL.26NO.1,13
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