HIV Incidence Among Men Who Have Sex With Men After Diagnosis With Sexually Transmitted Infections
HIV Incidence Among Men Who Have Sex With Men After Diagnosis With Sexually Transmitted Infections
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DOI：
10.1097/olq.0000000000000423
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发表时间：
2016-04-01
影响因子：
3.1
通讯作者：
Golden, Matthew R.
中科院分区：
文献类型：
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作者：
Katz, David A.;Dombrowski, Julia C.;Golden, Matthew R.
研究背景男男性行为者（MSM）在被诊断患有其他性传播感染（STI）后，是感染HIV的高危人群。确定性传播感染与随后的艾滋病毒感染的最大风险，可以帮助有针对性的预防干预措施，特别是暴露前预防（PrEP）。MethodsUsing匹配的艾滋病毒和性病监测数据从华盛顿州从2007年1月1日至2013年6月30日，我们计算了新的艾滋病毒诊断后，不同的性病诊断男男性行为者的发病率。在研究期间，男性在首次诊断STI时进入观察，并在艾滋病毒诊断或2013年6月30日退出。考克斯比例风险回归进行了全球比较rates.ResultsFrom 2007年1月1日至2013年6月30日，6577艾滋病毒阴性男男性接触者被诊断为有10,080细菌性传播感染在8371个独特的时间点，并遵循了17,419人年。280名（4.3%）男性随后被诊断为HIV感染，总发病率为1.6/100人-年（95%置信区间，1.4-1.8）。该州所有男男性行为者中艾滋病毒诊断的估计发病率为每100人年0.4人。男男性行为者在被诊断为直肠淋病后，（艾滋病毒发病率，每100人-年4.1例），其次是早期梅毒（2.8）、尿道淋病（1.6）、直肠衣原体感染（1.6）、咽部淋病（1.1）、晚期梅毒（1.0），尿道衣原体感染（0.6;总体P < 0.0001）结论与诊断为直肠淋病和早期梅毒的男性发生性关系的男性在STI后被诊断为HIV感染的风险最大。诊断.这些人应该优先接受更密集的预防干预措施，包括PrEP。
BackgroundMen who have sex with men (MSM) are at high risk for acquiring HIV infection after diagnosis with other sexually transmitted infections (STIs). Identifying the STIs associated with the greatest risk of subsequent HIV infection could help target prevention interventions, particularly preexposure prophylaxis (PrEP).MethodsUsing matched HIV and STI surveillance data from Washington State from January 1, 2007, to June 30, 2013, we calculated the incidence of new HIV diagnoses after different STI diagnoses among MSM. Men entered observation at the time of their first STI diagnosis during the study period and exited at HIV diagnosis or June 30, 2013. Cox proportional hazards regression was used to conduct a global comparison of rates.ResultsFrom January 1, 2007, to June 30, 2013, 6577 HIV-negative MSM were diagnosed as having 10,080 bacterial STIs at 8371 unique time points and followed for 17,419 person-years. Two hundred eighty (4.3%) men were subsequently diagnosed as having HIV infection for an overall incidence of 1.6 per 100 person-years (95% confidence interval, 1.4-1.8). The estimated incidence of HIV diagnoses among all MSM in the state was 0.4 per 100 person-years. Men who have sex with men were at the greatest risk for HIV diagnosis after being diagnosed as having rectal gonorrhea (HIV incidence, 4.1 per 100 person-years), followed by early syphilis (2.8), urethral gonorrhea (1.6), rectal chlamydial infection (1.6), pharyngeal gonorrhea (1.1), late syphilis (1.0), and urethral chlamydial infection (0.6; P < 0.0001 overall).ConclusionsMen who have sex with men diagnosed as having rectal gonorrhea and early syphilis were at the greatest risk for being diagnosed as having HIV infection after STI diagnosis. These men should be prioritized for more intensive prevention interventions, including PrEP.