Stable Incidence of HIV Diagnoses Among Danish MSM Despite Increased Engagement in Unsafe Sex
Stable Incidence of HIV Diagnoses Among Danish MSM Despite Increased Engagement in Unsafe Sex
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DOI：
10.1097/qai.0b013e31825af890
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发表时间：
2012-09-01
影响因子：
3.6
通讯作者：
Obel, Niels
中科院分区：
文献类型：
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作者：
Cowan, Susan Alice;Gerstoft, Jan;Obel, Niels
背景：自从引入高效抗逆转录病毒疗法（HAART）以来，丹麦男男性行为者（MSM）HIV阳性男性的患病率大幅增加。相比之下，MSM诊断出HIV的发生率并没有增加，这一悖论一直是激烈争论的焦点。方法：研究时间为1995-2010年。数据来自 2 个丹麦全国艾滋病毒和梅毒登记处以及 5 次关于丹麦男男性行为者性行为的连续调查。我们计算了 MSM 中 HIV 和梅毒的发病率、可检测病毒载量（> 400 HIV RNA 拷贝/mL）的 HIV 阳性 MSM 患病率，以及无保护肛交频率的变化。我们引入群组社区繁殖率 (CCRR) 来描述每年每个 HIV 阳性 MSM 中新诊断的 MSM 数量，并使用泊松回归来建立 CCRR 模型。结果：从 1995 年到 2010 年，丹麦 MSM 诊断出 HIV 的患病率从 1035 人增加到 1813 人（75%），而可检测病毒载量（> 400 HIV RNA 拷贝/mL）的 HIV 阳性 MSM 数量减少了从 1035 到 262，梅毒和无保护肛交的发病率急剧上升，而 CCRR 从 0.099（95% 置信区间：0.092 至 0.108）下降至 0.071（95% 置信区间：0.065 至 0.079）。结论：我们的结果强烈表明，HAART 降低了 HIV 传播的风险尽管不安全性行为有所增加，因此证实应向 MSM 提供 HAART 以降低疾病传播的风险。
Background: Since introduction of highly active antiretroviral therapy (HAART), the prevalence of Danish HIV-positive men who have sex with men (MSM) has increased substantially. In contrast, the incidence of MSM diagnosed with HIV has not increased, and this paradox has been the focus of intensive debate.Methods: Study period was 1995-2010. Data were obtained from 2 Danish nation-wide registries of HIV and syphilis, and 5 consecutive surveys on sexual behavior in Danish MSM. We calculated incidences of HIV and syphilis in MSM, prevalence of HIV-positive MSM with detectable viral load (>400 HIV RNA copies/mL), and changes in frequency of unprotected anal intercourse. We introduce The Cohort Community Reproductive Rate (CCRR) to describe the number of newly diagnosed MSM per HIV-positive MSM per year and used Poisson regression to model CCRR.Results: From 1995 to 2010, the prevalence of Danish MSM diagnosed with HIV increased from 1035 to 1813 (75%), whereas the number of HIV-positive MSM with detectable viral load (>400 HIV RNA copies/mL) decreased by 75% from 1035 to 262. The incidence of syphilis and unprotected anal intercourse rose dramatically in the same period, whereas CCRR decreased from 0.099 (95% confidence interval: 0.092 to 0.108) to 0.071 (95% confidence interval: 0.065 to 0.079).Conclusions: Our results strongly indicate that HAART has decreased the risk of transmission of HIV despite increased practice of unsafe sex and thereby substantiate that HAART should be offered to MSM to reduce risk of transmission of the disease.