Specific sex drug combinations contribute to the majority of recent HIV seroconversions among MSM in the MACS.
Specific sex drug combinations contribute to the majority of recent HIV seroconversions among MSM in the MACS.
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DOI：
10.1097/qai.0b013e3181a24b20
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发表时间：
2009-07-01
期刊：
影响因子：
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通讯作者：
Stall RC
中科院分区：
文献类型：
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作者：
Ostrow DG;Plankey MW;Cox C;Li X;Shoptaw S;Jacobson LP;Stall RC
在男男性行为者中观察到新的艾滋病毒感染。了解高危性行为、兴奋剂和勃起功能障碍药物使用与HIV血清转化的融合可能为重点干预提供方向。在随访期间（1998-2008年），我们在1,667名最初HIV血清阴性的男性中确定了57名HIV感染者。使用Cox比例风险回归分析对当前或以前半年就诊时使用的7种性药物（吸入亚硝酸盐或“poppers”、兴奋剂和EDDs）组合进行建模，调整其他风险因素，包括性行为、酒精和其他药物使用以及抑郁。然后计算基于模型的调整归因风险。血清转化的风险随着无保护的接受性肛交伴侣（URASP）的数量线性增加，风险比（HR）的范围从1个伴侣的1.73（95%置信区间[CI]: 0.75, 4.01）到2-4个伴侣的4.23 （95% CI: 1.76, 10.17）到5个以上伴侣的14.21 (95% CI: 6.27, 32.20)，独立于其他危险因素。调整后，仅使用兴奋剂（一种药物）的男性血清转换风险从2.99 （95% CI: 1.02, 8.76）增加到使用所有三种性药物的男性血清转换风险8.45 （95% CI: 2.67, 26.71）。在多中心艾滋病队列研究（MACS）中，使用7种可能的性-药组合中的任何一种，占9年HIV血清发病率的63%。当URASP和联合用药增加的贡献一起分析时，HIV血清转化的总归因风险为74%，其中41%归因于URASP单独，剩余33%归因于性药物使用的其他直接或间接影响。在这个队列中，使用罂粟、兴奋剂和EDDs显著增加了HIV血清转化的风险。这些数据加强了实施以减少药物为目标的干预措施的重要性，将其作为全面和有效的艾滋病毒预防战略的一部分。
New HIV infections are being observed among men who have sex with men. Understanding the fusion of risky sexual behaviors, stimulant and erectile dysfunction drug use with HIV seroconversion may provide direction for focused intervention. During the follow-up period (1998–2008) we identified 57 HIV seroconverters among 1,667 initially HIV-seronegative men. Time to seroconversion was modeled using Cox proportional hazards regression analysis for 7 combinations of sex-drugs (inhaled nitrites or “poppers”, stimulants, and EDDs) used at the current or previous semi-annual visit, adjusting for other risk factors including sexual behavior, alcohol and other drugs used, and depression. Model-based adjusted attributable risks were then calculated. The risk of seroconversion increased linearly with the number of unprotected receptive anal sex partners (URASP), with hazard ratios (HR) ranging from 1.73 (95% confidence interval [CI]: 0.75, 4.01) for 1 partner, to 4.23 (95% CI: 1.76, 10.17) for 2–4 partners to 14.21 (95% CI: 6.27, 32.20) for 5+ partners, independent of other risk factors. After adjustment, risks for seroconversion increased from 2.99 (95% CI: 1.02, 8.76) for men who reported using stimulants only (1 drug) to 8.45 (95% CI: 2.67, 26.71) for men who reported using all 3 sex-drugs. The use of any of the 7 possible sex-drug combinations accounted for 63% of the nine-year HIV seroincidence in the Multicenter AIDS Cohort Study (MACS). When contributions of increased URASP and combination drug use were analyzed together, the total attributable risk for HIV seroconversion was 74%, with 41% attributable to URASP alone and a residual of 33% due to other direct or indirect effects of sex-drug use. Use of poppers, stimulants and EDDs increased risk for HIV seroconversion significantly in this cohort. These data reinforce the importance of implementing interventions that target drug-reduction as part of comprehensive and efficacious HIV prevention strategies.