To describe the current situation of CD4, viral load of HIV and some risk behaviors of couples with one new detected infected HIV person was managed at outpatient clinic at Dienbien and Cantho provinces (2013 - 2014).
Trang 1
STATUS OF CD4 CELLS, HIV VIRAL LOAD AND RISK BEHAVIORS OF COUPLES HAVE ONE PEOPLE
INFECTED WITH HIV/AIDS
Doan Van Viet 1 ; Nguyen Thanh Long 2 ; Nguyen Van Hung 3
SUMMARY
Objectives: To describe the current situation of CD4, viral load of HIV and some risk
behaviors of couples with one new detected infected HIV person was managed at outpatient
clinic at Dienbien and Cantho provinces (2013 - 2014) Subjects and method: Cross-sectional
study was used; direct interviews with the couples on their some risk behaviors of tranmitted
HIV; blood tests of CD4 cells and HIV viral load A total of 133 couples with one new detected
infected HIV person (Dienbien: 98 pairs; Cantho 36 pairs) participated in this study Results:
About CD4 cells and viral load of HIV-infected people: the proportion of CD4 level at dengerous
(< 100 cells/µL could have meningitis at any time) and at very high risk (100 - < 350 cells/µL) of
the subjects were 20.9% and 26.1%, respectively The proportion of CD4 level at risk of
opportunistic infections (< 500 cells/µL) of the subjects was 64.9%; the proportion of HIV viral
load level at very high risk (1,000 - 100,000 copies/mL, easily transmitted through sex) and at
very dengerous (≥ 100,000 copies/mL, very dangerous to contact people) of the subjects were
52.0% and 40.2%, respectively; total was 92.2%; the total proportion of risk to transmit HIV to
other (HIV viral load level ≥ 20 copies/mL) was 95.3% Risk behaviors of couples: there were
6.7% of HIV-infected people who injected drugs within the past 3 months; 77.6% of spouses of
HIV-infected people believed that HIV-infected people still inject drugs within the past 3 months
24.6% of couples had one HIV-infected person having sex with each other within the past
3 months, of which 87.9% used condoms in sexual relations Conclusion: Proportion of
HIV-infected containing CD4 cell at dangerous level and very high risk level was 20.9% and 26.2%,
respectively and having viral load at very high risk level and very dangerous level to contacts
was 92.2% Over the past 3 months: 24.6% of couples having sex with each other (87.9% using
condom) and 77.6% of HIV negative spouses suppose HIV-infected individuals have still
injected drugs
* Keywords: HIV-infected people; CD4 cells; Viral load; Risk behavior; Couples
1 Hoankiem District Health Center
2 Central Propaganda and Training Commission
3 Vietnam Military Medical University
Corresponding author: Doan Van Viet (drviet67@gmail.com)
Dtae received: 30/08/2019
Date accepted: 10/10/2019
Trang 2
INTRODUCTION
The HIV epidemic in Vietnam is still
concentrated in the main infectious groups
and the main mode of infection is through
injecting drug Recent estimates showed
that sexually transmitted infections start to
account for a significant proportion and
often occur mainly among groups between
injecting drug users with their sexual
partners, between female sex workers
with their clients, between clients of sex
workers with their wives and homosexual
group including men and women having
sex with their partners High-risk behaviors
such as unsafe sex still prevail Integrated
monitoring of behavior and biological
indicators (IBBS) [1] and evaluation of
methadone replacement therapy (MMT)
in recent years have shown that the
proportion of people injecting drugs is low
and not frequent, of using condom when
having sex with female sex workers in the
injecting drug group last months was only
between 22% and 63% As for the sex
workers themselves, the rate of using
condoms when having sex with their clients
last month was only from 31% to 81%
The figures in Vietnam showed that
there were a significant number of couples
having sex with HIV Results of a survey
on 2,597 HIV-infected people in 22
provinces/cities indicated that 46% of the
partners of HIV-infected men are currently
negative or not aware of their HIV status,
while this rate was 15% for the female
partner/partner of HIV-infected women
About 40% of married HIV-infected people
are currently being treated at Bachmai
Hospital's outpatient clinic in the group of
couples who have HIV infection [2]
Dienbien and Cantho now belong to a group of key provinces affected by the HIV epidemic in Vietnam Dienbien is a northern mountainous province with a border with Laos, where HIV epidemic is
on the rise and has a great impact on the injecting drug users and their sexual partners The HIV prevalence rate of injecting drug users in 2009 in Dienbien was 56% [3] The HIV infection detection rate of pregnant mothers according to key surveillance results was 1.5% in 2010, and was the highest in the country Cantho is the southern province of the Mekong Delta with a combination of HIV infection patterns, with a significant number
of HIV-infected sex workers HIV prevalence among injecting drug users in the province
in 2009 was 32%, while this rate among female sex workers was 16% [4] In both provinces, injecting HIV infection is still the main mode of infection However, until now, there have been no studies in two provinces to find out, and characterize risk behaviors among HIV-infected couples Therefore, we conducted a study aimed
at: Describing the actual situation of CD4
cells, viral load of HIV and some risk behaviors of the couples with one new
management at outpatient clinics in Dienbien and Cantho provinces (2013 - 2014)
SUBJECTS AND METHODS
1 Subjects, location and time of study
* Subjects:
Couples, in which, one of them visit an outpatient clinic in Dienbien, Cantho to seek HIV counseling and testing and are confirmed to be HIV positive
Trang 3
* Criteria for selecting research subjects:
Existing couples have regular sex (including
homosexual or heterosexual); 18 years
old and older, living in Dienbien and
Cantho during the study period; one of
them was confirmed positive, the other
was negative; they both accepted to
participate in the study (meaning that they
both consulted couples, who have HIV (+)
to accept ART immediately)
* Time and location of study: This
study was conducted from 2013 to 2104
at Dienbien province and Cantho city
2 Methods
* Study design: The cross-sectional study
* Sampling and sample size: Appling
the formula for descriptive research [5]:
n = Z2(1-α/2)
Inside: n: Minimum sample size; α:
Significance levels (α = 0.05); z: Reliability
taken at the probability threshold, α = 0.05,
Z(1-α / 2) = 1.96; p: Percentage of HIV-infected
people participating in HIV counseling and
testing (estimated) was determined that
their spouse was currently negative or
their HIV status was unknown, taking
p = 0.50 (1 - p = 0.50); d: Absolute error,
expected d = 5% (d = 0.09)
Replace the values in the formula to
calculate n = 118 pairs Estimate the
rejection rate in the study by about 10% to
maintain the accuracy of the results, the
calculated sample body was 130 pairs
Actually investigated 133 couples
The Respondent Driven Sampling (RDS)
was used First, based on the list of
HIV-infected people that the research
team knew or were introduced by peer educators, three couples with HIV-negative
"seeds" was selected as the first study participants After the interview, each pair
of participants (who will become selectors) would receive 03 invitation cards to invite other HIV-infected couples that they knew
to participate in the study If HIV-infected couples in the community received an invitation card and wish to participate, they could take an invitation card and went to HIV counseling and testing facility
to do research The selection process used three such votes to continue until enough sample size stops
* Methods and techniques for data collection:
- Direct interview subjects of this study included both husband and wife, in which, there was a HIV-positive person and a HIV-negative person
- Test: Determining the HIV infection status based on the national guidelines, blood samples were tested by rapid test and then confirmed by EIA test and Murex HIV Ag/Ab test CD4 cells were tested at AIDS Centers in Dienbien and Cantho HIV viral load were tested at Bachmai Hospital in Hanoi (with samples obtained from Dienbien) and at Pasteur Institute in Hochiminh City (with samples obtained from Cantho)
* Data processing methods:
Data was entered with Epidata 3.1 software and was analyzed with SPSS software 11.5 Using descriptive statistical tests to analyze results Using frequency tables describe frequencies and rates according to research variables
2 ) 1 (
d p
p −
Trang 4
* Research ethics:
The study was approved at the Ethics
Council of the Hanoi University of Public
Health before formal implementation The consent of the study was recorded by both subjects in the HIV-positive couple
RESULTS
1 Current situation of CD4 cells and viral load of HIV/AIDS in HIV-infected subjects
Table 1: Decomposition of CD4 cells in HIV-infected subjects
Decomposition of CD4 cells
- The proportion of CD4 cells at dangerous levels (< 100 cells/µL) and at very high risk (100 - < 350 cells/µL) can threaten meningitis at any time, in general of the two provinces was 21.1% and 26.3% (Dienbien: 16.3% and 28.6%; Cantho: 34.3% and 20.0%)
- The total number of people at risk of opportunistic infections (CD4 < 500 cells/µL)
of the two provinces was 65.4% (Dienbien: 64.3%; Cantho: 68.6%)
The difference of blood levels of CD4 cells in HIV-infected people between Dienbien and Cantho provinces was not statistically significant (Chi2 test, p > 0.05)
Table 2: Number of CD4 cells in HIV-infected subjects
HIV-infected people had the lowest number of CD4 cells/µL of only 1 - 2 cells (almost lost CD4 cells); the highest from 1,231 - 1,308 cells/µL Median values fluctuate from 348 to 375 cells/µL The average number of CD4 cells in HIV-infected people in Dienbien and Cantho, respectively: 336.9 (95%CI: 336.9 - 437.8) and 378.3 (95%CI:
Trang 5
260.6 - 495,9) The average difference in CD4 cells in HIV-infected people between the two provinces was not statistically significant (p > 0.05)
Table 3: Classification of HIV viral load in HIV-infected subjects
Dienbien (n = 98)
Cantho (n = 29)
Total (n = 127)
Classification of HIV viral load
(copy/mL)
Very high risk (1000 - < 100,000) 52 53.1 14 48.3 66 52.0
The rate of viral load was under the
detection level, very good (< 20
copies/mL) and at a good level (20 - <
200 copies/mL; the level of non-sexually
transmitted) accounted for a very low rate,
in the two provinces 4.7% (Dienbien:
5.1%; Cantho: 3.4%)
The majority of HIV-infected people
had very high viral load (1,000 -
< 100,000 copies/mL; easy sexually
transmitted) and very dangerous levels (≥ 100,000 copies/mL; very dangerous for people contact), of the two provinces was 92.2% (Dienbien: 90.8%; Cantho: 96.6%)
The total number of people who were
at risk of HIV transmission to surrounding people (the amount of HIV virus at ≥ 200 copies/mL) was very high, of the two provinces was 95.3% (Dienbien: 94,9%;
Cantho: 96.6%)
Table 4: HIV viral load (HIV/mL) in HIV-infected subjects
95%CI of medium 155,829.5 - 516,989.2 133,522.6 - 702,960.9 202,954.7 - 507,121.0
Among those with HIV viral load exceeding the threshold (Dienbien: 95 people;
Cantho: 28 people) showed that: the lowest viral load was from 50 - 1,170 copies/mL
Trang 6
and the highest was 3,410,000 - 5,850,000 copies/mL Median values were in the
range of 63,400 - 93,300 copies/mL The average of viral load on HIV-infected subjects
in Dienbien: 336,409.4 (95%CI: 155,829.5 - 516,989.2), Cantho: 418,241.8 (95%CI:
133,522.6 - 702,960.9)
2 Some risk behaviors of couples with HIV infection
Table 5: Actual situation of drug injection behavior of HIV-infected people in the past
3 months
Dienbien (n = 98) Cantho (n = 36) Total (n = 134) Drug injection behavior
Do not use new needles and
Sharing needles and syringes
with wife/husband in the past
3 months
Inside
Sharing needles and syringes
with others in the past 3 months 7 100.0 1 50.0 8 88.9
The rate of injecting drug in the last 3 months of the HIV-infected people in the
2 provinces was 6.7% (Dienbien: 7.1%; Cantho: 5.6%) The difference in injection rates
between the two provinces was not statistically significant (Chi2 test, p > 0.05) There
were 6/7 people in Dienbien and 2/2 people in Cantho did not use new needles and
syringes the last time; 7/7 people in Dienbien and 1/2 people in Cantho shared needles
with spouses and with others within the past 3 months
Table 6: Prediction of spouses on drug injection status of HIV-infected people in the
past 3 months
Drug injection status of
Spouses of HIV-infected people believed that HIV-infected people who were still
injecting drugs in the last 3 months were 77.6% (Dienbien: 69.4%; Cantho: 100%) In
Dienbien, 22.4% of spouses of HIV-infected people did not know whether people with
HIV continue to inject drugs
Trang 7
Table 7: Sexual behavior in the past 3 months of HIV-infected spouses
Sexual behavior
Inside
The rate of couples having one HIV-infected person had sex with each other in the past 3 months was 24.6% (Dienbien: 19.4%; Cantho: 38.9%) In sex behavior, couples who used condoms, two provinces were 87.9% (Cantho: 100%; Dienbien: 78.9%)
Table 8: The fact that couples of HIV-infected people had access to support services
for detoxification, health care and HIV prevention
Types of services
Wife/husband of HIV-infected people in the two provinces mainly accessed and used medical examination and treatment and health care services in general health facilities (commune/ward health stations, clinics ) in Dienbien 80.6% and Cantho 69.4%
DISCUSSION
* About CD4 cells in HIV-infected people:
In 2013, the CD4 index was a good
indicator of whether HIV destroyed the
immune system of an HIV-infected person
and it indicated the risk of infection and
the time to start treatment And in 2013,
people with HIV with a CD4 count below
350 cells/µL were indicated for ART In our study, the prevalence of CD4 cells was dangerous and at a very high risk, which could threaten meningitis at any time, in the two provinces of 21.1% and 26.3, respectively (Dienbien: 16.3% and 28.6%; Cantho: 34.3% and 20.0%) The total number of subjects at risk of opportunistic infections (CD4 < 500 cells/µL)
Trang 8
in the two provinces was 65.4% The CD4
average number of HIV-positive people
averaged 384.9 and 47.0% CD4 was
below 350 Thus, nearly half of those who
were positive spouses were at risk of
threatening health complications and had
indicated ARV treatment However, WHO
has recommended HIV prevention by
using ARV treatment for HIV-infected
people should start sooner regardless of
the CD4 count of HIV-infected people
would have a positive impact on minimizing
the possibility of HIV infection from
HIV-infected people to their negative
spouses/partners [6]
* About HIV viral load of HIV-infected
people:
Rakai's team chaired by Thomas Quinn
followed 415 couples who did not co-infected
with HIV in Uganda for 30 months to assess
the impact of some biological risk factors,
and behavior including viral load in
heterosexual transmission Research had
shown that the risk of transmission to
uninfected partners varies significantly
based on different viral load levels The
average level of serum HIV-1 RNA was
significantly higher in patients with HIV
transmission (90,254 copies/mL) compared
to patients who did not transmit the virus
(38,029 copies/mL) No HIV transmission
occurred from HIV patients with viral load
< 1,500 copies/mL Of the 90 cases of
infection, 23% were transmitted from infected
partners with viral load at around 400 to
9,999 copies/mL, 40% had an amount of
10,000 to 49,999 copies/mL, 37% had
a load of about > 50,000 copies/mL
Based on this analysis, more than 75% of
cases had a viral load of more than
10,000 copies/mL [7] The results of our
study showed that the majority of HIV-infected people had very high risk of viral load (1,000 - < 100,000 copies/mL) easily transmitted through sexual contact and very dangerous level (≥ 100,000 copies/mL), very dangerous for contacts, general of
2 provinces was 92.2% (Dienbien: 90.9%;
Cantho: 96.6%) The total number of people
at risk of HIV infection in surrounding people accounted for 95.3% of the two provinces
* Regarding the risk behaviors of HIV-positive couples/husbands:
Research results showed that 6.7% of injecting drug users in the last 2 months of the two provinces were 6.7% (Dienbien:
7.1%; Cantho: 5.6%) However, spouses
of infected people believed that HIV-infected people were still injecting drugs within the past 3 months, in general, the two provinces were 77.6% (Dienbien: 69.4%;
Cantho: 100%) Although the two injecting drug rates of HIV-infected people of the two respondents were very different, they all reflected the fact that HIV-infected people using injecting drugs were at risk
of HIV/AIDS infection to the community was unavoidable
Sexual behavior without condoms with regular partners was a high risk of HIV infection The research results showed that the proportion of couples with one HIV-infected person having sex with each other in the past 3 months, in general of the two provinces was 24.6% (Dienbien:
19.4%; Cantho: 38.9%) In sex behavior, couples who used condoms, in two provinces were 87.9% (Cantho: 100%; Dienbien:
78.9%) Thus, the risk of HIV infection from infected people to spouses was still negative and high in Dienbien Therefore,
Trang 9
there was a need to raise awareness for
HIV-infected people as well as those at
high risk of HIV infection on the regular
use of condoms when had sex with a
spouse or partner
CONCLUSION
Proportion of HIV-infected containing
CD4 cell at dangerous level and very high
risk level (21.1% and 26.3%) was at risk,
chance of opportunistic infection (65.4%),
respectively and having viral load at very
high risk level and very dangerous level to
contacts (92.2%); total risk of infection
HIV for surrounding people accounts for a
very high rate (95.3%) Over the past
3 months: 24.6% of couples having sex
with each other (including 87.9% of
couples using condom) and 77.6% of HIV
negative spouses suppose HIV-infected
individuals have still injected drugs
REFERENCES
1 National Institute of Hygiene and
Epidemiology Results of the HIV/STI Integrated
Biological and Behavioral Surveillance (IBBS)
in Vietnam Round III - 2013 and the trend through 03 rounds of the article look up 2014
2 Vietnam Authority of HIV/AIDS Control
Antiretroviral therapy for HIV infection prevention in serodifferent couples in Vietnam Project of Vietnam Ministry of Health and WHO on "Suppressive ART for HIV transmission
in serodifferent couples, version 13.0" 2012
3 Dienbien Center of HIV/AIDS Control
Report on results of HIV/AIDS prevention and control in 2015 and key directions and tasks in
2016 2015
4 Cantho Center of HIV/AIDS Control
Report No 21/BC-AIDS on the results of HIV/AIDS prevention and control in 2015 and key directions and tasks in 2016 2015
5 Hanoi Medical University Epidemiology
and statistics applied in scientific research Medical Publishing House 1999, p.32
6 WHO Antiretroviral Treatment as Prevention
(TasP) of HIV and TB 2012
7 Quinn T.C et al Viral load and heterosexual
transmission of human immunodeficiency virus type 1 Rakai Project Study Group
N Engl J Med 2000, 342 (13), pp.921-929.