ABSTRACT
Nineteen Brazilian HIV-infected hemophiliacs and their stable heterosexual sexual partners were studied with the aim of assessing the rate of HIV transmission in this at risk group. The mean length of relationship between couples was 7.4 years. The hemophiliac men were Class II (n = 6), III (n = 11) and IVa (n = 2) of the CDC classification. They had decreased CD4+ and elevated CD8+ cell numbers; five had p24 antigenemia. We found 3 HIV-infected women (15.8 percent) by routine and confirmatory tests, a prevalence similar to that seen in other countries. They were asymptomatic and had no detectable p24 antigenemia. The 3 seropositive women's partners were Class II and III-CDC, and had normal CD4+ and CD8+ values and no p24 antigenemia. All seronegative women also had normal CD4+ and CD8+ numbers, except for elevated CD8+ cells in three of them, but immune abnormalities had already been seen in some seronegative partners at high risk for HIV infection. Our results reinforce previous suggestions that heterosexual transmission to stable female partners occurs preferentially early after initiation of sexual exposure, and possibly when the transmitter had high levels of viremia and regular sexual activity.
PIP: In Brazil, hemophiliacs who received coagulation factor concentrates during 1980-85 have rates of HIV exceeding 50% and rates of heterosexual transmission to their partners in the range of 10-20%. This study investigated the clinical course of HIV infection in 19 male patients from a hematology center in Sao Paulo, Brazil, with hemophilia A or B and their stable, asymptomatic female sexual partners. The mean duration of the relationship was 7.4 years. Compared with 15 normal adult subjects used as controls, CD8+ cell counts of hemophiliacs were significantly higher while CD4+ cell values were significantly reduced. Three sexual partners (15.8%) were HIV-positive, implying a transmission rate of 2.1 per 100 person-years. All female partners were in Centers for Disease Control Class II. Their male partners were in Classes II and III and had normal CD4+ and CD8+ levels. Neither males nor females had p24 antigenemia. Fragments of HIV particles were present in several HIV-negative female partners. These findings suggests early HIV transmission, when the transmitter has high levels of viremia, to stable female partners of hemophiliacs.
