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HIV Infection and Pregnancies in Sexual Partners of HIV- Seropositive Hemophilic Men -- United States

Seroprevalence rates for antibody to human immunodeficiency virus (HIV) have been reported to range from 33% to 92% for patients in the United States with hemophilia A and from 14% to 52% for those with hemophilia B (1-7). The cumulative incidence of AIDS is currently estimated at 3% (345 cases) for U.S. patients with hemophilia A and at 1% (23 cases) for those with hemophilia B. The cumulative AIDS incidence for seropositive patients varies from region to region and is reported to be as high as 18% in one hemophilia treatment center (HTC) in Pennsylvania (8). Because sexual partners of infected men are also at risk for HIV infection (9,10), the National Hemophilia Foundation (NHF) has developed extensive educational programs to inform patients with hemophilia and their sexual partners about the risks of HIV transmission.

The Division of Host Factors, Center for Infectious Diseases, CDC, and NHF conducted a survey of all U.S. HTCs and physicians known to treat patients with hemophilia. NHF estimates that those surveyed provide medical care for at least 75% of the hemophilic men in the United States. The purpose of the survey was to determine 1) whether sexual partners of known HIV-seropositive hemophilic men were being tested for HIV antibody *, 2) the HIV seroprevalence rate among those partners who had been tested, and 3) the extent of compliance with NHF and Public Health Service recommendations for preventing sexual and perinatal transmission of HIV (11,12).

Questionnaires were sent to 246 HTCs and physicians. Two hundred and thirty- seven (96%) responded, either in writing (123) or to follow-up telephone inquiries (114). Nine addressees (4%) either could not be reached or chose not to provide the requested information.

The 237 respondents provided information concerning 2,276 spouses/sexual partners of a comparable number of HIV seropositive hemophilic patients ** (Table 1). Seven hundred and seventy-two (34%) of the spouses/sexual partners were known to have been serologically tested for HIV antibody. Of those tested, 77 (10%) were reported to be seropositive. Among all spouses/sexual partners, 280 (12%) were reported to have been pregnant during the period January 1985 through March 1987 (Table 1). One hundred and seventy (61%) of these women had been tested for HIV antibody; 22 (13%) of those tested were seropositive for HIV prior to pregnancy, during pregnancy, or at delivery.?s Six hundred and two (30%) nonpregnant spouses were tested; 55 (9%) were seropositive.

Twenty children had been born to these 22 seropositive women, two of whom were pregnant twice. One of these 24 pregnancies was therapeutically aborted, and the outcomes of three others were not reported. Thirteen (65%) of the children born to HIV-seropositive women had been tested for HIV antibody. Four (31%) were seronegative, and nine (69%) were seropositive. Because the infants' ages at the time of antibody testing were not given, it was not possible to determine whether the positive results reflect passively transferred maternal antibody or infection of the infant. None of the 20 children born to seropositive mothers have yet been diagnosed as having AIDS. Reported by: Hemophilia Treatment Centers. National Hemophilia Foundation. Div of Host Factors, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note:

The reported rate of HIV seropositivity among spouses/sexual partners of seropositive hemophilic men in this survey is consistent with findings in earlier studies (9,10). However, these rates should not be generalized to all U.S. hemophilic households because a number of limitations must be taken into account when interpreting the findings of this survey:

  • The survey dealt only with spouses/sexual partners of known HIV-seropositive hemophilic patients. (NHF recommends voluntary HIV-antibody testing of hemophilic patients, along with appropriate pre- and post-test counseling.)

  • A higher proportion of pregnant women than nonpregnant women had been tested (61% compared with 30%, pless than 0.0001). This finding suggests that some women may have been tested because they were pregnant or wished to become pregnant.

  • HTCs and physicians have routine interaction with their hemophilic patients, but they may not interact as frequently or as closely with their patients' families or sexual partners. Therefore, HTCs and physicians may not be aware of the health status of their patients' family members/sexual partners. They may also be unaware of testing performed at other locations, e.g., by obstetricians.

    Abstention from sexual intercourse would eliminate any risk of

sexually transmitted HIV infection (13). The use of condoms, and possibly condoms in conjunction with spermicides, will reduce the risk of HIV transmission. However, even when condoms are properly used for each act of sexual intercourse, infected patients and their sexual partners should fully understand that some risk remains (14). In accordance with PHS guidelines, health-care personnel should provide hemophilic patients and their sexual partners with thorough, confidential, and individualized counseling (12).

References

  1. Jason J, Holman RC, Kennedy MS, Evatt BL. Longitudinal assessment of hemophiliacs exposed to HTLV-III/LAV (Abstract). In: Program and abstracts of the 26th Interscience Conference on Antimicrobial Agents and Chemotherapy. New Orleans, Louisiana: 26th Interscience Conference on Antimicrobial Agents and Chemotherapy, 1986:97.

  2. Jason J, McDougal JS, Holman RC, et al. Human T-lymphotropic retrovirus type-III/ lymphadenopathy-associated virus antibody: association with hemophiliacs' immune status and blood component usage. JAMA 1985;253:3409-15.

  3. Ragni MV, Tegtmeier GE, Levy JA, et al. AIDS retrovirus antibodies in hemophiliacs treated with factor VIII or factor IX concentrates, cryoprecipitate, or fresh frozen plasma: prevalence, seroconversion rate, and clinical correlations. Blood 1986;67:592-5.

  4. Goedert JJ, Sarngadharan MG, Eyster ME, et al. Antibodies reactive with human T cell leukemia viruses in the serum of hemophiliacs receiving factor VIII concentrate. Blood 1985;65:492-5.

  5. Kreiss JK, Kitchen LW, Prince HE, et al. Human T cell leukemia virus type III antibody, lymphadenopathy, and acquired immune deficiency syndrome in hemophiliac subjects: results of a prospective study. Am J Med 1986;80:345-50.

  6. Gjerset GF, McGrady G, Counts RB, et al. Lymphadenopathy-associated virus antibodies and T cells in hemophiliacs treated with cryoprecipitate or concentrate. Blood 1985;66:718-20.

  7. Waskin H, Smith KJ, Simon TL, Gribble TJ, Mertz GJ. Prevalence of HTLV-III antibody among New Mexico residents with hemophilia. West J Med 1986;145:477-80.

  8. Eyster ME, Gail MH, Ballard JO, Al-Mondhiry H, Goedert JJ. Natural history of human immunodeficiency virus infections in hemophiliacs: effects of T-cell subsets, platelet counts, and age. Ann Intern Med 1987;107:1-6.

  9. Jason JM, McDougal JS, Dixon G, et al. HTLV-III/LAV antibody and immune status of household contacts and sexual partners of persons with hemophilia. JAMA 1986;255:212-5.

  10. Kreiss JK, Kitchen LW, Prince HE, Kasper CK, Essex M. Antibody to human T-lymphotropic virus type III in wives of hemophiliacs: evidence for heterosexual transmission. Ann Intern Med 1985;102:623-6.

  11. National Hemophilia Foundation. Hemophilia and acquired immunodeficiency syndrome (AIDS): intimacy and sexual behavior. In: AIDS update, September 1985. New York: National Hemophilia Foundation, 1985:3-4.

  12. CDC. Public Health Service guidelines for counseling and antibody testing to prevent HIV infection and AIDS. MMWR 1987;36:509-15.

  13. CDC. Additional recommendations to reduce sexual and drug abuse-related transmission of human T-lymphotropic virus type III/lymphadenopathy-associated virus. MMWR 1986; 35:152-5.

  14. Fischl MA, Dickinson GM, Scott GB, Klimas N, Fletcher MA, Parks W. Evaluation of heterosexual partners, children, and household contacts of adults with AIDS. JAMA 1987;257:640-4.

* The issue of counseling was not addressed.

** The vast majority of hemophilic men are reported to be monogamous. Respondents were not asked to indicate the number of HIV-seropositive hemophilic male partners represented by this survey. 

*** Respondents were not asked to indicate at what stage during pregnancy testing was performed or why these women were tested for HIV antibody.

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