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Discordant Couple Study
      #10001 - 09/23/00 05:39 PM

Someone asked about studies on discordant couples. Here are some. Others that I've seen are definitive in that when there is a seroconversion, it is usually with the woman and not the man.

Among HIV-discordant couples (those with only a single HIV-positive partner), heterosexual transmission is approximately eight times more efficient from male to female. Most infections have occurred by the vaginal route, although participation in rectal sex enhances the risk.(20-22) The cumulative incidence of transmission between discordant couples suggests an approximate 20% risk of transmission from male to female after unprotected sex over a sustained period in a fixed partnership. Female-to-male transmission is less efficient, at least in prospectively followed research subjects.(23,24) A study from Northern California, which began prospectively following patients in 1985, found that only 2 (2.4%) of the 82 male partners of HIV-infected females became infected, but 68 or (19%) of the 360 female partners became infected.(20,21) Male-to-female transmission per sexual contact infectivity in this study was estimated to be 0.0009.(20)

A study of 256 HIV-discordant couples in Japan found only 12 cases of seroconversion. None of those occurred in couples that used condoms faithfully (a total of 124 couples and 15,000 experiences). Some other couples chose abstinence. Those that did engage in unprotected sex were at greater risk if the HIV-positive partner was in advanced stages vs. asymptomatic (48% vs. 7%).

In one study of serodiscordant couples in the U.S., none of 123 partners who used condoms consistently seroconverted, whereas 12 of 122 seronegative partners (10%) who used condoms inconsistently became infected (CDC: MMWR 42:589-591, 1993). When person-years at risk were considered, the rate for HIV transmission among couples reporting consistent condom use was 1.1 per 100 person-years of observation, compared with 9.7 per 100 person-years among inconsistent users (Saracco A, et al: J Acquir Immune Defic Syndr 6:497-502, 1993). Condom use also reduces the risk for other sexually transmitted diseases, including gonorrhea, HSV, genital ulcers, and pelvic inflammatory disease, all of which may facilitate transmission of HIV.

This protection is most evident from studies of couples in which one member is infected with HIV and the other is not, i.e., "discordant couples." In a 2- year study of discordant couples in Europe, among 124 couples who reported consistent use of latex condoms, none of the uninfected partners became infected. In contrast, among the 121 couples who used condoms inconsistently, 12 (10 percent) of the uninfected partners became infected.

In another study, among a group of 134 discordant couples who did not use condoms at all or did not use them consistently, 16 partners (12 percent) became infected. This contrasts markedly with infections occurring in only 3 partners (2 percent) of the 171 couples in this study who reported consistently using condoms over the 2-year period.

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