Peer-reviewed article

Increasing sero-discordancy among young HIV infected pregnant women from India: a likely pointer of changing transmission dynamics.

Ritu Parchure, Shrinivas Darak, Vijaya Jori, Asha Hegde, Anoop Kumar Puri et al. · 27 Mar 2019

Summary

Written by AI, not yet AICS's view · claude-haiku-4-5-20251001

This study analyzed HIV prevalence data among pregnant women in India to understand changing transmission patterns. It found that sero-discordancy (where the pregnant woman is HIV-positive but her husband is not) increased from 16% in 2007 to 36% in 2016-17. Younger women aged 18-23 and first-time mothers showed higher rates of sero-discordancy. The authors suggest these trends indicate changing HIV transmission dynamics and growing vulnerability among young women.

Key points

Sero-discordancy among married pregnant women with HIV increased from 16% in 2007 to 36% in 2016-17
Women aged 18-20 were 2.68 times more likely to be sero-discordant compared to women aged 36-40
First-time mothers (primi-parous women) were 1.84 times more likely to be sero-discordant than women with previous pregnancies
The increasing trend in younger women suggests rising HIV risk in unmarried women populations
Study analysed 1,209 currently married pregnant women living with HIV, of which 302 (25%) were sero-discordant

Limitations

This is an observational analysis of program data that identifies trends but cannot determine causation or explain the mechanisms behind changing transmission dynamics. The study does not assess or evaluate any intervention for preventing HIV or improving child outcomes.

Abstract

The flat-lining of HIV incidence in India has raised concerns about the presence of emerging risk groups. As HIV prevalence among pregnant women is reflective of the situation in general population, its closer scrutiny provides valuable insights about the evolving epidemic. The present study assesses temporal trends of sero-discordance (where woman is HIV infected and husband is uninfected), among pregnant women living with HIV (pWLHIV) from India. Data of program for prevention of parent to child transmission of HIV was analyzed. Statistical analysis was done using Cochrane-Armitage trend test and logistic regression. Of the 1209 currently married pWLHIV, 302 (25%) were sero-discordant. The proportion increased from 16% in 2007 to 36% in 2016-17 (p = 0.000). The likelihood of sero-discordance was higher for women aged 18-20 (OR: 2.68, CI: 1.30-5.83) and 21-23 (OR: 1.98, CI: 1.01-4.15) years compared to 36-40 years; and for primi-parous women (OR: 1.84, CI: 1.31-2.58) compared to women pregnant for second/third time. The findings are indicative of changing HIV transmission dynamics. Steeper rise in sero-discordance in younger women implies an increasing risk of HIV in unmarried women population. A better understanding of HIV specific vulnerabilities of young women, married and unmarried, is warranted.