HIV Seroconversion in Serodiscordant Couples: An Experience from Malaysia

Many evidences support the use of antiretroviral therapy (ART) and condom in reducing the transmission of HIV through heterosexual contact especially in serodiscordant couples. Thus, this study aimed to determine the prevalence and factors associated with HIV seroconversion in serodiscordant couples in Kelantan, Malaysia. Methods: This was a case-control study involving 161 HIV serodiscordant couples on follow-up in Raja Perempuan Zainab II Hospital. Sociodemographic and clinical characteristics as well as sexual background were obtained from medical records. Data were analyzed using SPSS version 22.0. Results: The prevalence of HIV seroconversion in serodiscordant couples in Kelantan was 28.6% (95% CI: 22.2-36.0%) with a total of 46 spouses were infected. The mean (SD) age of index partners was 28.0 (6.3) years old with male predominance (62.1%, n=100). Only 8 (5.0%) spouses received pre-exposure prophylaxis and all of them remained HIV-negative. It was found that 84.5% (n=136) were adherent to ART while 50.3% (n=81) couples were compliant to condom use. The majority of index partners had baseline CD4 count <200 cells/µL (56.8%, n=84) and latest HIV viral load <50 copies/ml (82.9%, n=97). In the multivariable analysis, gender (AOR 0.313; 95% CI 0.117-0.835; p=0.020), ART adherence (AOR 0.121; 95% CI 0.030-0.486; p=0.003) and condom compliance (AOR 0.007; 95% CI 0.001-0.060; p<0.001) were determined as factors associated with HIV seroconversion. Conclusion: Kelantan had a high prevalence of HIV seroconversion in serodiscordant couples. Seronegative female spouses had increased risk of HIV infection especially when the index partners were nonadherent to ART and condom use. Couples-based educational intervention is crucial in minimizing the spread of HIV transmission.