Abstract
ABSTRACTOBJECTIVE To characterize recent HIV infections among newly diagnosed men who have sex with men and transgender women in Tijuana.METHODS Limiting Antigen (LAg)-Avidity testing was performed to detect recent HIV infection within a cohort of newly-diagnosed men who have sex with men and transgender women in Tijuana. Logistic regression was used to determine characteristics associated with recent infection. A partial transmission network was inferred using HIV-1 pol sequences. Tamura-Nei 93 genetic distances were measured between all pairs of sequences, and the network was constructed by inferring putative transmission links (genetic distances ≤ 1.5%). We assessed whether recent infection was associated with clustering within the inferred network.RESULTS Recent infection was detected in 11% (22/194) of newly-diagnosed participants. Out of the participants with sequence data, 60% (9/15) with recent infection clustered compared with 31% (43/139) with chronic infection. Two recent infections belonged to the same cluster. In adjusted analyses, recent infection was associated with years of residence in Tijuana (OR = 1.5; 95%CI 1.01–1.09), cocaine use (past month) (OR = 8.50; 95%CI 1.99–28.17), and ever experiencing sexual abuse (OR = 2.85; 95%CI 1.03–7.85).DISCUSSION A total of 11% of men newly diagnosed with HIV who have sex with men and transgender women in Tijuana were recently infected. The general lack of clustering between participants with recent infection suggests continued onward HIV transmission rather than an outbreak within a particular cluster.
Highlights
Individuals who are in the primary stages of infection are responsible for a disproportionate number of new infections through several factors, including higher viral loads and being unaware of their status[1,2]
Available estimates suggest that HIV prevalence has increased over time from 11% in a 1991 convenience sample of MSM8, to 18.9% in a 2002 convenience sample of MSM9, and 20% (95%CI 12.5–29.1) in a 2014 sample of men who have sex with men (MSM) and transgender women (TW) recruited by respondent-driven sampling (RDS)[7]
Data come from Proyecto Enlaces (Links Project), which was designed to compare the effectiveness of partner contact tracing (PCT) and venue-based sampling (VBS) for identifying undiagnosed infection among MSM and TW in Tijuana[14]
Summary
Individuals who are in the primary stages of infection are responsible for a disproportionate number of new infections through several factors, including higher viral loads and being unaware of their status[1,2]. Available estimates suggest that HIV prevalence has increased over time from 11% in a 1991 convenience sample of MSM8, to 18.9% in a 2002 convenience sample of MSM9, and 20% (95%CI 12.5–29.1) in a 2014 sample of MSM and TW recruited by respondent-driven sampling (RDS)[7]. Whereas these estimates are not sufficient to establish a trend considering the disparate and non-probabilistic sampling techniques applied, they are all notably high and have remained high over the past few decades. Reducing new transmissions is a key goal in the public health response to HIV10
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