High HIV and Ulcerative Sexually Transmitted Infection Incidence Estimates Among Men Who Have Sex With Men in Peru: Awaiting for an Effective Preventive Intervention

Abstract

Background In the Andean Region, HIV and sexually transmitted infections (STI) are most prevalent among men who have sex with men (MSM), but incidence estimates and associated factors have never been prospectively assessed. Methods A cohort of 1056 high-risk HIV-negative MSM in Lima, Peru, was recruited during 1998–2000 (The ALASKA Cohort) and a nested case-control analysis conducted between seroconverters and non-seroconverters, matched 1:3 by age and duration of follow-up for comparison of risk behaviors, acute retroviral symptoms, circumcision, and STI. Results During average follow-up of 335 days, 34 men seroconverted, providing a HIV incidence estimate of 3.5/100 person-years (95% CI: 2.3–4.7). High syphilis (9.2/100 person-years, 95% CI: 6.7–10.1) and HSV-2 infection (10.4/100 person-years, 95% CI: 8.6–11.9) incidence estimates were obtained. HIV seroconverters were more likely than men who remained seronegative to report fever ≥3 days (46% vs. 7%), to seek medical care (62% vs. 27%), and to have ≥1 casual partner (86.2% vs. 74.1%) since their last visit. HIV seroconverters also were more likely to have acquired syphilis or HSV-2 infection (31% vs. 8% among initially HSV-2 seronegative men) while were less likely to be circumcised (4.2% vs. 20.6%, a non-significant difference). In multivariate analysis, incident syphilis or HSV-2 infection (OR: 5.9, 95% CI 1.5–22.7) and sex with any casual partner (OR: 4.8, 95% CI: 0.9–26.2) were associated with HIV seroconversion. Conclusions STI that may cause anogenital ulcers are important risk factors for HIV acquisition among high-risk MSM in Lima, a population with a very high HIV incidence estimate. Synergistic interventions focusing in preventing both HIV and HSV-2, like male circumcision, are warranted to be assessed, especially in MSM populations with low levels of circumcision and high incidence estimates of ulcerative STI.

Provider Attitudes Toward Oral Preexposure Prophylaxis for HIV Prevention Among High-Risk Men Who Have Sex with Men in Lima, Peru

“…In Peru, while the prevalence and incidence of HIV in the general population are only 0.5% 3 and 0.03%, 4 respectively, men who have sex with men (MSM) and transgender women (TGW) experience rates that are comparable to those reported among heterosexual populations in sub-Saharan Africa. [5][6][7][8] As in many other settings, MSM and TGW in Peru are in great need of effective and easy to implement prevention strategies.…”

Laboratory Evaluation of a Dual Rapid Immunodiagnostic Test for HIV and Syphilis Infection

“…Additionally, syphilis infection, like other genital ulcer diseases, may facilitate HIV acquisition and transmission (8)(9)(10). In coinfected patients, syphilis can increase transmission of HIV by increasing viral shedding at the site of genital ulcers (11,12) and increasing the HIV load (13,14).…”

Acceptability of Oral versus Rectal HIV Preexposure Prophylaxis among Men Who Have Sex with Men and Transgender Women in Peru

“…[9][10][11][12] In these populations, URAI is common and highly associated with prevalent and incident HIV infection. 10,12 To better understand the feasibility of implementing potential PrEP interventions in MSM and TGW at high HIV risk in Peru, we assessed the acceptability of using efficacious ARV-based product formulations to prevent HIV administered either orally everyday or rectally in conjunction with URAI.…”