Abstract
ObjectiveTo provide HIV seroincidence data among men who have sex with men (MSM) in the United States and to identify predictive factors for seroconversion.MethodsFrom 1998–2002, 4684 high-risk MSM, age 18–60 years, participated in a randomized, placebo-controlled HIV vaccine efficacy trial at 56 U.S. clinical trial sites. Demographics, behavioral data, and HIV status were assessed at baseline and 6 month intervals. Since no overall vaccine efficacy was detected, data were combined from both trial arms to calculate HIV incidence based on person-years (py) of follow-up. Predictors of seroconversion, adjusted hazards ratio (aHR), were evaluated using a Cox proportional hazard model with time-varying covariates.ResultsOverall, HIV incidence was 2.7/100 py and was relatively uniform across study sites and study years. HIV incidence was highest among young men and men reporting unprotected sex, recreational drug use, and a history of a sexually transmitted infection. Independent predictors of HIV seroconversion included: age 18–30 years (aHR = 2.4; 95% CI 1.4,4.0), having >10 partners (aHR = 2.4; 95% CI 1.7,3.3), having a known HIV-positive male sex partner (aHR = 1.6; 95% CI 1.2, 2.0), unprotected anal intercourse with HIV positive/unknown male partners (aHR = 1.7; 95% CI 1.3, 2.3), and amphetamine (aHR = 1.6; 95% CI 1.1, 2.1) and popper (aHR = 1.7; 95% CI 1.3, 2.2) use.ConclusionsHIV seroincidence was high among MSM despite repeated HIV counseling and reported declines in sexual risk behaviors. Continuing development of new HIV prevention strategies and intensification of existing efforts will be necessary to reduce the rate of new HIV infections, especially among young men.
Highlights
Human immunodeficiency virus (HIV) infects,48,000 persons in the United States annually, and 57% of human immunodeficiency virus (HIV)/AIDS cases are reported among men who have sex with men (MSM) [1,2]
Rates of HIV infection among MSM in the United States declined in the late 1980s and early 1990s, subsequent data indicated increases in HIV infections, sexually transmitted infections (STIs), and unsafe sexual practices among this population [3,4,5,6,7,8,9,10,11,12,13,14,15]
Estimates of HIV seroincidence among U.S MSM are largely based on (1) small regional or local cohort studies which follow individuals for short time periods, (2) national HIV surveillance data from selected locations, and (3) cross-sectional studies or samples which use the BED HIV-1 assay within the serologic testing algorithm for recent HIV seroconversion (STARHS) to estimate HIV seroincidence
Summary
Human immunodeficiency virus (HIV) infects ,48,000 persons in the United States annually, and 57% of HIV/AIDS cases are reported among men who have sex with men (MSM) [1,2]. Large national MSM cohort studies remain the gold standard for HIV incidence estimates and can be utilized to provide data for a variety of age groups and geographic regions as well as valuable information on trends and risk factors for infection. From 1998–2002, a large multi-site phase III HIV vaccine efficacy trial was conducted among 5108 high-risk HIV-1 negative MSM and 309 heterosexual women in North America and the Netherlands; U.S MSM accounted for over 90% of study participants. Epidemiologic and behavioral data from this 36-month trial are useful for characterizing national trends in HIV incidence and identifying risk factors for HIV infection among U.S MSM
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