The Effect of High Rates of Bacterial Sexually Transmitted Infections on HIV Incidence in a Cohort of Black and White Men Who Have Sex with Men in Atlanta, Georgia
The Effect of High Rates of Bacterial Sexually Transmitted Infections on HIV Incidence in a Cohort of Black and White Men Who Have Sex with Men in Atlanta, Georgia
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DOI：
10.1089/aid.2015.0013
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发表时间：
2015-06-01
影响因子：
1.5
通讯作者：
Rosenberg, Eli S.
中科院分区：
文献类型：
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作者：
Kelley, Colleen F.;Vaughan, Adam S.;Rosenberg, Eli S.
缺乏报告艾滋病毒阴性的美国男男性行为者（MSM）性传播感染（STI）发病率的数据。此外，由于危险性行为混淆了细菌性性传播感染和艾滋病毒感染之间的关系，因此很难分析性传播感染对艾滋病毒感染的影响。InvolveMENT研究是对亚特兰大的黑人和白色HIV阴性、性活跃的MSM进行的纵向队列研究，他们接受了STI和HIV的常规筛查，并完成了行为问卷调查。计算尿道和直肠衣原体（CT）、淋病（GC）和梅毒的经性别校正的发病率，按种族分层。使用倾向评分加权的考克斯比例风险模型来估计STI对HIV发病率的影响，并计算STI的人群归因分数（PAF）。我们纳入了562例HIV阴性MSM，随访843人年。所有性传播感染的发病率都很高，特别是在黑人男男性行为者中。在使用倾向评分权重控制与STI和HIV相关的行为风险因素的校正分析中，直肠STI与随后的HIV发病率显著相关（aHR 2.7; 95% CI 1.2，6.4）。直肠STI的PAF为14.6（95% CI 6.8，31.4）。亚特兰大男男性接触者中性传播感染的高发病率以及在控制行为风险后直肠性传播感染与艾滋病毒感染的相关性，强调了性活跃男男性接触者中性传播感染常规筛查和治疗的重要性。我们的数据支持有针对性的艾滋病毒预防干预措施，如暴露前化学预防（PrEP），诊断为直肠性传播感染的亚特兰大男男性接触者。
Data reporting sexually transmitted infection (STI) incidence rates among HIV-negative U.S. men who have sex with men (MSM) are lacking. In addition, it is difficult to analyze the effect of STI on HIV acquisition given that sexual risk behaviors confound the relationship between bacterial STIs and incident HIV. 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 rectal Chlamydia (CT), gonorrhea (GC), and 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. 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). The 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 preexposure chemoprophylaxis (PrEP), for Atlanta MSM diagnosed with rectal STIs.