HIV transmission risk among serodiscordant couples: a retrospective study of former plasma donors in Henan, China.

Objectives: To estimate the HIV incidence and assess the behavioral, clinical, and quality-of-life risk factors for HIV transmission among serodiscordant couples from Henan Province, China. Methods: Between January 2006 and December 2008, initially seronegative spouses were tested for HIV at 6-month intervals. Retrospectively identified subjects were interviewed through face-to-face questionnaire. Cox proportional-hazards model was used to assess the relationship between risk factors and HIV seroconversion. Results: Of 1927 couples, 84 (4.3%) seroconversions occurred, representing a seroconversion rate of 1.71 per 100 person-years. Seroconversion rates increased over time. Not always using condoms [relative ratio (RR) = 8.42; 95% confidence interval (CI): 4.83 to 14.67], sexual activity >= 4 times per month (RR = 5.24; 95% CI: 2.55 to 10.77), not switching antiretroviral treatment regimen (RR = 1.99; 95% CI: 0.85 to 4.65), and a quality-of-life score <12 on the psychological domain (RR = 2.33; 95% CI: 1.21 to 4.48) were associated with increased risk of seroconversion. Seventy-one percent of index spouses were on antiretroviral therapy. There was no association between rate of HIV seroconversion and last recorded CD4 cell count level of the index spouse. Conclusions: Effective HIV prevention interventions targeting discordant couples should focus on sustaining health education, increasing psychosocial support services, and increasing medication adherence monitoring.