[HIV transmission in newly reported HIV infected couples before diagnoses in five provinces, China, 2011-2014]

Objective: To understand the HIV transmission and associated factors in newly reported HIV infected couples before diagnosis. Methods: The information about newly reported HIV infected couples in Yunnan, Guangxi, Sichuan, Henan and Xinjiang provinces (autonomous region) were collected from National HIV/AIDS Information System from 2011 to 2014. The infection order of the sero-concordant couples were determined. Logistic regression model was used to analyze the HIV transmission between couples and identify the associated factors. Cochran-Armitage trend analysis was conducted to understand the annual sero-concordant couple proportion. Results: A total of 48 931 HIV cases in couples were included in this study, among whom 12 051(24.6%) were sero-concordant couples, indicating HIV transmissions occurred between them. Multivariate logistic regression analysis showed that those who were females (OR=1.98, 95%CI: 1.89-2.08), aged >45 years (45-59 yrs: OR=1.32, 95% CI: 1.23-1.42; >60 yrs: OR=1.72, 95% CI: 1.58-1.86), had educational level of middle school education or below (illiteracy and primary school: OR=1.33, 95%CI: 1.23-1.44; middle school: OR=1.19, 95% CI: 1.10-1.28), were farmers or migrate workers (OR=1.23, 95% CI: 1.17-1.30), were infected through injecting drug use or heterosexual intercourse (injecting drug use: OR=1.33, 95% CI: 1.03-1.72; heterosexual intercourse: OR=3.65, 95% CI: 2.89-4.61), had CD₄⁺T cells of <500 cells/μl (<200 cells/μl: OR=5.05, 95%CI: 4.62-5.52; 200-349 cells/μl: OR=3.58, 95%CI: 3.26-3.93; 350-500 cells/μl: OR=2.14, 95%CI: 1.94-2.36), reported unprotected sexual behaviors (OR=1.56, 95% CI: 1.49-1.64), were more likely to infect their couples before diagnosis. The HIV transmission proportion between couples before diagnosis decreased significantly from 28.9% (2 631/9 102) in 2011 to 25.5% (3 009/11 787) in 2014 among those infected through heterosexual intercourse. Conclusion: The proportion of HIV transmission between couples before diagnosis varied among different populations. Behavior intervention and early HIV test promoting are needed to prevent HIV transmission between couples before diagnosis in populations at high risk for HIV infection. HIV infection cases should be included in the HIV care system after diagnosis as early as possible.