Risk Factors for Acute and Early HIV Infection Among Men Who Have Sex With Men (MSM) in San Diego, 2008 to 2014

Abstract

The objectives of this study were to identify risk factors associated with acute and early HIV infection (AEH) among men who have sex with men (MSM) undergoing community HIV testing and to compare demographics in those diagnosed with AEH with those diagnosed at chronic stage of HIV infection.In this retrospective cohort study, we analyzed risk factors associated with AEH among 8925 unique MSM (including 200 with AEH [2.2%] and 219 [2.5%] with newly diagnosed chronic HIV infection) undergoing community-based, confidential AEH screening in San Diego, California.The combination of condomless receptive anal intercourse (CRAI) plus ≥5 male partners, CRAI with an HIV-positive male, CRAI with a person who injects drugs, and prior syphilis diagnosis were significant predictors of AEH in the multivariable Cox regression model. Individuals reporting ≥1 of these 4 risk factors had a hazard ratio of 4.6 for AEH. MSM diagnosed with AEH differed in race (P = 0.005; more reported white race [P = 0.001], less black race [P = 0.030], trend toward less Native American race [P = 0.061]), when compared to those diagnosed with chronic HIV infection, while there was no difference observed regarding age.We established a multivariate model for the predicting risk of AEH infection in a cohort of MSM undergoing community HIV screening, which could be potentially used to discern those in need of further HIV nucleic acid amplification testing for community screening programs that do not test routinely for AEH. In addition, we found that race differed between those diagnosed with AEH and those diagnosed at chronic stage of HIV infection underlining the need for interventions that reduce stigma and promote the uptake of HIV testing for black MSM.

Clear Links Between Starting Methamphetamine and Increasing Sexual Risk Behavior

“…The “Early Test” is a community-based, confidential AEH screening program that provides point of care rapid HIV serologic testing followed by routine reflex to HIV NAT in all antibody (Ab) negative persons 22, 23 . The UCSD Human Research Protections Program approved the study protocol, consent and all study related procedures.…”

“…To this end, this study characterized the temporal relationship between methamphetamine use and sexual risk behavior among HIV uninfected MSM undergoing community-based screening for acute and early HIV infection (AEH) in San Diego, California 22, 23 .…”

Costs per Diagnosis of Acute HIV Infection in Community-based Screening Strategies: A Comparative Analysis of Four Screening Algorithms

“…Participants were MSM who reported sexual contact with men during the 12 months prior to testing. Basic demographics, risk behaviors, and frequency of repeat HIV testing from this cohort have been published previously [20][21][22]. An estimated date of infection was calculated for all recently infected persons using previously published criteria for serologic and virologic test results [23].…”

High HIV incidence in men who have sex with men following an early syphilis diagnosis: is there room for pre-exposure prophylaxis as a prevention strategy?

“…Syphilis was an independent predictor of HIV acquisition (HR 4.67) in a cohort in San Diego, USA, although a subanalysis of risk factors for HIV in those infected with syphilis was not performed 9. Syphilis also emerged as an independent risk factor for HIV acquisition, although to a lesser extent, in similar studies of larger populations: Pathela et al 10 found a 5.6/100 PYFU incidence of HIV in MSM in New York City, USA, while in iPrEX, Solomon et al 8 found a 7.3/100 PYFU incidence.…”