Factors associated with HIV seroconversion in gay men in England at the start of the 21st century
Factors associated with HIV seroconversion in gay men in England at the start of the 21st century
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DOI：
10.1136/sti.2007.027946
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发表时间：
2007-02-01
影响因子：
3.6
通讯作者：
Evans, B. G.
中科院分区：
文献类型：
--
作者：
Macdonald, N.;Elam, G.;Evans, B. G.
目的：检测和量化目前在性健康诊所寻求重复检测的男同性恋者艾滋病病毒血清转化的危险因素。设计：在英国伦敦、布莱顿和曼彻斯特进行的无与伦比的病例对照研究。方法：75例患者（在过去2年内HIV检测呈阴性后最近HIV检测呈阳性）和157例对照组（在过去2年内HIV检测呈阴性后最近HIV检测呈阴性）完成了计算机辅助的自我访谈，重点是在HIV检测之间的性行为和生活方式。结果：病例和对照组在社会人口统计学、开始与男性发生性行为的年数、终生艾滋病毒检测次数、先前进行艾滋病毒检测的原因以及最后一次艾滋病毒检测之间的间隔（平均= 10.5个月）方面相似。检测之间的危险因素包括与非HIV阴性伴侣进行无保护的接受性肛交（URAI）（调整优势比（AOR）和95%置信区间4.1、1.8至9.3），其中风险增加与同时使用亚硝酸盐吸入剂、接受射精和伴侣数量增加有关。与一人以上男性无保护插入性肛交（UIAI） （AOR 2.7, 1.3至5.5）和使用亚硝酸盐吸入剂（AOR 2.4, 1.1至5.2）也存在独立风险。结论：无保护肛交仍然是男同性恋者传播艾滋病病毒的主要途径，与接受性伴侣、接受射精和使用亚硝酸盐吸入剂相关的风险增加。尽管人们普遍认识到URAI的HIV传播风险，但本研究强调了UIAI的风险，并且当HIV暴露发生时，亚硝酸盐吸入剂可能是传播的重要促进因素。
Objectives: To detect and quantify current risk factors for HIV seroconversion among gay men seeking repeat tests at sexual health clinics.Design: Unmatched case control study conducted in London, Brighton and Manchester, UK.Methods: 75 cases (recent HIV positive test following a negative test within the past 2 years) and 157 controls (recent HIV negative test following a previous negative test within the past 2 years) completed a computer-assisted self interview focused on sexual behaviour and lifestyle between HIV tests.Results: Cases and controls were similar in sociodemographics, years since commencing sex with men, lifetime number of HIV tests, reasons for seeking their previous HIV tests and the interval between last HIV tests (mean= 10.5 months). Risk factors between tests included unprotected receptive anal intercourse (URAI) with partners not believed to be HIV negative (adjusted odds ratio (AOR) and 95% confidence interval 4.1, 1.8 to 9.3), where increased risk was associated with concomitant use of nitrite inhalants, receiving ejaculate and increasing numbers of partners. Independent risk was also detected for unprotected insertive anal intercourse (UIAI) with more than one man (AOR 2.7, 1.3 to 5.5) and use of nitrite inhalants (AOR 2.4, 1.1 to 5.2).Conclusions: HIV serodiscordant unprotected anal intercourse remains the primary context for HIV transmission among gay men, with increased risk associated with being the receptive partner, receiving ejaculate and use of nitrite inhalants. Although the HIV transmission risk of URAI is widely acknowledged, this study highlights the risk of UIAI and that nitrite inhalants may be an important facilitator of transmission when HIV exposure occurs.