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Double Drug Use, Double No-Condom Sex Boost HIV Risk With Already-Positive Partner
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AIDS 2020: 23rd International AIDS Conference Virtual, July 6-10, 2020
Mark Mascolini
Partners of US residents who already have HIV run a greater risk of getting HIV themselves if both partners inject drugs or both partners have condom-free sex, but not if only one or the other has those traits [1]. This 43,000-person study by the Centers for Disease Control and Infection (CDC) also confirmed that men who have sex with men (MSM) run a bigger risk of picking up HIV from a sex partner than non-MSM partners.
Partner services programs help people diagnosed with HIV (the index person) tell their sex partners or needle-sharing partners that those partners may have been exposed to HIV. But until now researchers have not deeply tapped partner services data to learn which partners of already infected people stand the greatest chance of becoming infected themselves.
To address that question, CDC researchers explored HIV risk factors in partners of index persons diagnosed with HIV infection in partner services programs. The investigators used multivariate binomial regression to weigh associations between several factors and becoming infected with HIV. Those factors are age, race/ethnicity, and index-partner paired risk behaviors (injection drug use [IDU], sex without a condom in the past 12 months, and male-to-male sex partnerships). Data came from 61 CDC-funded state and local health departments in the years 2013-2017.
Among 103,481 index-partner pairs, the researchers identified 43,420 tested partners, of whom 35,636 tested HIV-negative, had a previous positive HIV test, or had an indeterminate HIV status. That left 7784 partners (18% of 43,420) diagnosed with HIV in these partner services programs.
Newly diagnosed HIV in a partner was least frequent in partners aged 25-34 (16.9%) and more frequent in those aged 13-24 (17.2%), 35-44 (18.0%), or 45-98 (19.6%). Multivariate analysis determined that partners 25-34 years old were 10% less likely to be newly diagnosed with HIV than those 13-24 years old (adjusted prevalence ratio [aPR] 0.90, 95% confidence interval [CI] 0.84 to 0.98). In a similar analysis, black or Hispanic partners were no more likely to be newly diagnosed with HIV than white partners.
Index (originally infected) persons 45 or older were 20% more likely to infect a partner than index persons 13-24 years old (aPR 1.20, 95% CI 1.06 to 1.36). Compared with white index persons, those of other nonblack, non-Hispanic race/ethnicity were 20% less likely to infect a partner (aPR 0.80, 95% CI 0.66 to 0.97).
Next the researchers reckoned the impact of shared index-partner characteristics versus neither the index person nor the partner having that characteristic. HIV transmission to a partner was no more likely if either the index person or the newly infected partner was an IDU than if neither was an IDU. But if both the index person and the partner were IDUs, HIV transmission to the partner was about 80% more likely than if neither was an IDU (aPR 1.79, 95% CI 1.39 to 2.30).
Similarly, HIV transmission to a partner was no more likely if either the index person or the newly infected partner had sex without condoms than if neither person had sex without condoms. But if both the index person and the partner had sex without condoms, HIV transmission to the partner was twice more likely than if neither person had sex without condoms (aPR 1.97, 95% CI 1.79 to 2.18).
If the index person and the partner were MSM, HIV transmission to the partner was 15% more likely than if they were not MSM (aPR 1.15, 95% CI 1.07 to 1.23). Finally, compared with people who lived in Western US states, HIV transmission from index person to partner was about 40% more likely among people who lived in the Northeast (aPR 1.42, 95% CI 1.24 to 1.62), 3 times more likely among people who lived in the South (aPR 3.07, 95% CI 2.78 to 3.39), and 4.6 times more likely among people who lived in the Midwest (aPR 4.63, 95% CI 4.01 to 5.35).
The researchers stressed that partner notification services, like the ones that supplied data for this analysis, spot a higher percentage of undiagnosed HIV infection in partners than routine or targeted HIV testing [2,3]. Partner services programs are more likely to help reduce HIV transmission, the CDC team added, if those program "address behavioral risk characteristics that increase the vulnerability of partners to HIV and prioritize services to those at greatest risk of infection."
References
1. Song W, Mulatu MS, Rao S, et al. Factors associated with HIV positivity among partners of HIV-diagnosed persons in the United States, 2013-2017. AIDS 2020: 23rd International AIDS Conference Virtual. July 6-10, 2020. Abstract PEC0400.
2. Centers for Disease Control and Prevention. CDC Fact Sheet: HIV in the United States and Dependent Areas. https://www.cdc.gov/hiv/statistics/overview/ataglance.html.
3. Centers for Disease Control and Prevention. CDC-funded HIV testing: United States, Puerto Rico, and the U.S. Virgin Islands, 2017. Published December 2018. http://www.cdc.gov/hiv/library/reports/index.html.
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