HIV Incidence Among Men With and Those Without Sexually Transmitted Rectal Infections: Estimates From Matching Against an HIV Case Registry
ABSTRACT Background. Sexually transmitted bacterial rectal infections are objective markers of HIV risk behavior. Quantifying HIV risk among men who have sex with men (MSM) who have had these infections can inform prevention efforts. We measured HIV risk among MSM who have and have not been diagnosed with rectal Chlamydia trachomatis (CT) and/or rectal Neisseria gonorrhoeae (GC). Methods. HIV incidence among a cohort of 276 HIV-negative MSM diagnosed with rectal CT and/or GC in New York City sexually transmitted disease (STD) clinics was compared to HIV incidence among HIV-negative MSM without these infections. Matches against the citywide HIV/AIDS registry identified HIV diagnoses from STD clinics, and by other providers. Cox proportional hazards models were used to explore factors associated with HIV acquisition among MSM with rectal infections. Results. HIV-negative MSM with rectal infections (>70% of which were asymptomatic) contributed 464.71 person-years of follow-up. Among them, 31 (11.2%) were diagnosed with HIV, of which 14 (45%) were diagnosed by non-STD clinic providers. The annual HIV incidence was significantly higher among MSM with rectal infections (6.67%, 95% CI: 4.61-9.35) than among MSM without rectal infections (2.53%, 95% CI: 1.31-4.42). Black race (hazard ratio=4.98; 95% CI: 1.75-14.17) was associated with incident HIV among MSM with rectal CT/GC. Conclusions. One in 15 MSM with rectal infections was diagnosed with HIV within a year, a higher risk than for MSM without rectal infections. Such data has implications for screening for rectal STD, and may be useful for targeting populations for risk-reduction counseling and other HIV prevention strategies, such as pre-exposure prophylaxis.
- SourceAvailable from: Carlos Del RioBMC Medical Research Methodology 12/2015; 15(1). DOI:10.1186/s12874-015-0017-y · 2.17 Impact Factor
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ABSTRACT: Pre-exposure prophylaxis (PrEP) is the first biomedical intervention with proven efficacy to reduce human immunodeficiency virus (HIV) acquisition in men who have sex with men (MSM) and transgender women (TGW). Little is known about levels of interest and characteristics of individuals who elect to take PrEP in real-world clinical settings. The US PrEP Demonstration Project is a prospective, open-label cohort study assessing PrEP delivery in municipal STD clinics in San Francisco and Miami and a community health center in Washington, DC. HIV-uninfected MSM and TGW seeking sexual health services at participating clinics were assessed for eligibility and offered up to 48 weeks of emtricitabine/tenofovir for PrEP. Predictors of enrollment were assessed using a multivariable Poisson regression model, and characteristics of enrolled participants are described. Of 1069 clients assessed for participation, 921 were potentially eligible and 557 (60.5%) enrolled. In multivariable analysis, participants from Miami (aRR 1.53; 95% CI 1.33-1.75) or DC (aRR 1.33; 95% CI 1.2-1.47), those who were self-referred (aRR 1.48; 95% CI 1.32-1.66), with prior PrEP awareness (aRR 1.56; 95% CI 1.05-2.33) and those reporting >1 episode of anal sex with an HIV-infected partner in the last 12 months (aRR 1.20; 95% CI 1.09-1.33) were more likely to enroll. Almost all (98%) of enrolled participants were MSM, and at baseline, 63.5% reported condomless receptive anal sex in the prior three months. Interest in PrEP is high among a diverse population of MSM at risk for HIV infection when offered in STD and community health clinics.JAIDS Journal of Acquired Immune Deficiency Syndromes 12/2014; DOI:10.1097/QAI.0000000000000479 · 4.39 Impact Factor
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ABSTRACT: Background: Data reporting sexually transmitted infection (STI) incidence rates among HIV-negative US MSM are lacking. In addition, it is difficult to analyze the effect of STI on HIV acquisition given sexual risk behaviors confound the relationship between bacterial STIs and incident HIV. Methods: The InvolveMENt study was a longitudinal cohort of black and white HIV-negative, sexually active MSM in Atlanta who underwent routine screening for STI and HIV and completed behavioral questionnaires. Age-adjusted incidence rates were calculated for urethral and retal Chlamydia (CT), gonorrhea (GC), and for syphilis, stratified by race. Propensity-score weighted Cox proportional hazards models were used to estimate the effect of STI on HIV incidence and calculate the population attributable fraction (PAF) for STI. Results: We included 562 HIV-negative MSM with 843 person-years of follow-up in this analysis. High incidence rates were documented for all STIs, particularly among black MSM. Having a rectal STI was significantly associated with subsequent HIV incidence in adjusted analyses (aHR 2.7; 95% CI 1.2, 6.4) that controlled for behavioral risk factors associated with STI and HIV using propensity score weights. The PAF for rectal STI was 14.6 (95% CI 6.8, 31.4). Conclusions: High incidence of STIs among Atlanta MSM and the association of rectal STI with HIV acquisition after controlling for behavioral risk underscore the importance of routine screening and treatment for STIs among sexually active MSM. Our data support targeting intensive HIV prevention interventions, such as PrEP, for Atlanta MSM diagnosed with rectal STIs.AIDS Research and Human Retroviruses 02/2015; 31(6). DOI:10.1089/AID.2015.0013 · 2.46 Impact Factor