High HIV-1 incidence, correlates of HIV-1 acquisition, and high viral loads following seroconversion among MSM

Abstract

Background HIV-1 incidence estimates and correlates of HIV-1 acquisition in African men who have sex with men are largely unknown. Methods Since 2005, HIV-1-uninfected men who reported sex with men and women (MSMW) or sex with men exclusively (MSME) were followed at scheduled visits for collection of behavioural and clinical examination data and plasma for HIV-1 testing. Urethral or rectal secretions were collected from symptomatic men to screen for gonorrhoea. Poisson regression methods were used to estimate adjusted incidence rate ratios (aIRR) to explore associations between risk factors and incident HIV-1 infection. Plasma viral loads (PVL) were assessed over two years following seroconversion. Results Overall HIV-1 incidence in 449 men was 8.6 (95% confidence interval [CI]: 6.7–11.0) per 100 person-years (py). Incidence was 5.8 (95% CI: 4.2–7.9) per 100 py among MSMW, and 35.2 (95% CI: 23.8–52.1) per 100 py among MSME. Unprotected sex, receptive anal intercourse, exclusive sex with men, group sex, and gonorrhoea in the past 6 months were strongly associated with HIV-1 acquisition, adjusted for confounders. PVL in seroconverters was >4 log10 copies/mL at 230 (73.4%) of 313 visits in MSMW and 153 (75.0%) of 204 visits in MSME. Conclusions HIV-1 incidence is very high among MSM in coastal Kenya, and many seroconverters maintain high PVL for up to two years after infection. Effective HIV-1 prevention interventions, including treatment as prevention, are urgently needed in this population.

2016 United Kingdom national guideline on the sexual health care of men who have sex with men

“…The presence of an acute STI, such as syphilis, chlamydia and gonorrhoea, is associated with increased HIV acquisition (228), the strongest association being with rectal infections (94,95,229). HIV incidence varied by the rate of incident syphilis, when controlled for known predictors of HIV in the iPrEx study of HIV PrEP (230).…”

Australian sexually transmissible infection and HIV testing guidelines for asymptomatic men who have sex with men 2014: a review of the evidence

“…[44][45][46] Irrespective of antiretroviral therapy, urethral chlamydia or gonorrhoea can increase seminal HIV viral load and thus infectiousness among HIV-positive MSM. 47 Therefore, regular STI testing among HIV-positive MSM is likely to have public as well as individual health benefits.…”

Prevalence and Incidence of HIV Infection among Fishermen along Lake Victoria Beaches in Kisumu County, Kenya

“…Earlier studies observed that HIV seroconversion was associated with incident STI infections: syphilis [30] [32] and gonorrhea [27]. This suggests that these infections potentially increase susceptibility to HIV infection, but more importantly that they share a mode of transmission and thus are biological markers for exposure to unprotected sexual behavior.…”

“…Seeley et al (2012) found an HIV incidence rate of 4.9 person-years among fishing communities (with 5.2 person-years among men) on the shores of Lake Victoria in Uganda [25]. New HIV infection rate of 3.9 per 100 person-years was observed among men reporting high-risk sexual behavior [26] and 5.8 per 100 person-years among bisexual MSM [27] in Costal Kenya. Similarly, HIV incidence of 6.1 per 100 person-years was found among exclusive MSM in Mombasa, Kenya [28], while 3.4 per 100 person-years [29] and 5.4 per 100 person-years [30] observed among MSM in China.…”