HIV-1-discordant couples in sub-Saharan Africa: explanations and implications for high rates of discordancy.
In sub-Saharan Africa, approximately 1 in 2 HIV-1-infected persons living in a couple have a serodiscordant partner. Recent data suggest a large proportion of new HIV-1 infections in mature epidemics occur within discordant couples, making discordancy a major contributor to the spread of HIV/AIDS in Africa. What accounts for high rates of HIV-1 discordance and why some individuals remain uninfected despite repeated sexual exposure to HIV-1 is unknown. Studying HIV-1-discordant couples may contribute to understanding correlates of HIV-1 immunity and acute infection. Additionally, HIV-1-discordant couples are an important population for prevention efforts. Consequently, HIV-1-discordant couples are increasingly viewed as a valuable source of participants for HIV vaccine and prevention trials. This review summarizes and critiques existing data on HIV-1-discordant couples in developing countries, including an analysis of transmission rates within discordant couples, description of biological and behavioral characteristics important in planning HIV-1 vaccine and prevention trials, and challenges faced when carrying out such studies.
Guthrie
Brandon L
BL
Department of Epidemiology, University of Washington, Seattle, WA 98104-2499, USA.
de Bruyn
Guy
G
Farquhar
Carey
C
D016915:AIDS Vaccines; D017954:Africa South of the Sahara / Q000453:epidemiology; D003906:Developing Countries; D018562:Disease Transmission, Infectious; D005191:Family Characteristics; D005260:Female; D015658:HIV Infections / Q000517:prevention & control / Q000635:transmission*; D015497:HIV-1 / Q000472:pathogenicity*; D020010:Heterosexuality; D006801:Humans; D008297:Male; D012747:Sexual Partners
D016915:AIDS Vaccines