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De Bellis A, Willemsen MS, Guzzetta G, van Sighem A, Romijnders KAGJ, Reiss P, Schim van der Loeff MF, van de Wijgert JHHM, Nijhuis M, Kretzschmar MEE, Rozhnova G. Model-based evaluation of the impact of a potential HIV cure on HIV transmission dynamics. Nat Commun 2025; 16:3527. [PMID: 40263248 PMCID: PMC12015233 DOI: 10.1038/s41467-025-58657-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Accepted: 03/27/2025] [Indexed: 04/24/2025] Open
Abstract
The development of an HIV cure is a global health priority, with the target product profile (TPP) for an HIV cure guiding research efforts. Using a mathematical model calibrated to data from men who have sex with men (MSM) in the Netherlands, we assessed whether an effective cure could help end the HIV epidemic. Following the TPP, we evaluated two scenarios: (i) HIV remission, where the virus is suppressed in an individual without ongoing antiretroviral therapy (ART) but may rebound, and (ii) HIV eradication, which aims to completely remove the virus from the individual. Here, we show that sustained HIV remission (without rebound) or HIV eradication could reduce new HIV infections compared to a scenario without a cure. In contrast, transient HIV remission with a risk of rebound could increase new infections if rebounds are not closely monitored, potentially undermining HIV control efforts. Our findings emphasize the critical role of cure characteristics in maximizing cure benefits for public health and highlight the need to align HIV cure research with public health objectives to end the HIV epidemic.
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Grants
- Aidsfonds, The Netherlands, grant number P-53902 Aidsfonds & NWO, The Netherlands, the SPIRAL project KICH2.V4P.AF23.001 Aidsfonds, The Netherlands, grant number P-52901
- Aidsfonds & NWO, The Netherlands, the SPIRAL project KICH2.V4P.AF23.001
- Aidsfonds & NWO, The Netherlands, the SPIRAL project KICH2.V4P.AF23.001 Aidsfonds, The Netherlands, grant number P-52901
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Affiliation(s)
- Alfredo De Bellis
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy.
- Department of Mathematics, University of Trento, Trento, Italy.
| | - Myrthe S Willemsen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Giorgio Guzzetta
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy
| | | | - Kim A G J Romijnders
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Peter Reiss
- Amsterdam UMC, location University of Amsterdam, Department of Global Health and Infectious Diseases, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Global Health and Quality of Care, Amsterdam, The Netherlands
- Amsterdam Institute for Immunology and Infectious Diseases, Infectious Diseases Program, Amsterdam, The Netherlands
| | - Maarten F Schim van der Loeff
- Amsterdam Public Health Research Institute, Global Health and Quality of Care, Amsterdam, The Netherlands
- Amsterdam Institute for Immunology and Infectious Diseases, Infectious Diseases Program, Amsterdam, The Netherlands
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Janneke H H M van de Wijgert
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Monique Nijhuis
- Translational Virology, Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
- HIV Pathogenesis Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Mirjam E E Kretzschmar
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Center for Complex Systems Studies (CCSS), Utrecht University, Utrecht, The Netherlands
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Ganna Rozhnova
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
- Center for Complex Systems Studies (CCSS), Utrecht University, Utrecht, The Netherlands.
- BioISI-Biosystems & Integrative Sciences Institute, Faculty of Sciences, University of Lisbon, Lisbon, Portugal.
- Faculty of Sciences, University of Lisbon, Lisbon, Portugal.
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Vanbellinghen MC, Boyd A, Kootstra NA, Schim van der Loeff MF, van der Valk M, Reiss P. A Biomarker Profile Reflective of Preserved Thymic Function Is Associated With Reduced Comorbidities in Aging People With HIV: An AGEhIV Cohort Analysis. J Infect Dis 2025; 231:622-632. [PMID: 39658325 DOI: 10.1093/infdis/jiae603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Revised: 11/22/2024] [Accepted: 12/06/2024] [Indexed: 12/12/2024] Open
Abstract
BACKGROUND People with HIV (PWH) experience a higher burden of aging-associated comorbidities, the underlying mechanisms of which remain to be fully elucidated. We aimed to identify profiles based on immune, inflammatory, and aging biomarkers in blood from PWH and controls, and explore their association with total comorbidities over time. METHODS Latent profile analysis was used to construct biomarker profiles in AGEhIV cohort participants (94 with well-controlled HIV on antiretroviral therapy [ART] and 95 controls without HIV) using baseline measurements of selected biomarkers. Factors associated with profile membership were assessed by multivariable logistic regression. The association between profiles and mean total comorbidities during follow-up was assessed by Poisson regression, stratified by HIV status. Comorbidities included type 2 diabetes, non-AIDS malignancies, cardiovascular disease, osteoporosis, chronic kidney disease. and frailty. RESULTS Three biomarker profiles were identified: "high thymic output/low inflammation" (HT/LI) profile (n = 27 PWH, n = 9 controls), "low thymic output/high inflammation" (LT/HI) profile (n = 29 PWH, n = 26 controls), and an "intermediate" profile (n = 38 PWH, n = 60 controls). Only HIV status was significantly associated with profile membership. PWH, relative to controls, more often exhibited the HT/LI profile compared to other profiles. In PWH, but not in controls, the HT/LI profile was associated with significantly lower mean comorbidities during a median 8.0 years (interquartile range, 7.1-8.1) of follow-up. CONCLUSIONS People aging with well-controlled HIV on ART were more likely to exhibit a biomarker profile indicative of preserved thymic function and less chronic inflammation compared to controls. PWH with such a profile seemed relatively protected from developing aging-associated comorbidities. CLINICAL TRIALS REGISTRATION NCT01466582.
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Affiliation(s)
- Manon C Vanbellinghen
- Department of Infectious Diseases, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam, The Netherlands
- Department of Global Health, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Anders Boyd
- Department of Infectious Diseases, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam, The Netherlands
- HIV Monitoring Foundation, Amsterdam, The Netherlands
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Neeltje A Kootstra
- Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam, The Netherlands
- Department of Experimental Immunology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Maarten F Schim van der Loeff
- Department of Infectious Diseases, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam, The Netherlands
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Marc van der Valk
- Department of Infectious Diseases, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam, The Netherlands
- HIV Monitoring Foundation, Amsterdam, The Netherlands
| | - Peter Reiss
- Department of Infectious Diseases, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam, The Netherlands
- Department of Global Health, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
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Teslya A, Heijne JCM, van der Loeff MFS, van Sighem A, Roberts JA, Dijkstra M, de Bree GJ, Schmidt AJ, Jonas KJ, Kretzschmar ME, Rozhnova G. Impact of increased diagnosis of early HIV infection and immediate antiretroviral treatment initiation on HIV transmission among men who have sex with men in the Netherlands. PLoS Comput Biol 2025; 21:e1012055. [PMID: 40014624 PMCID: PMC11882050 DOI: 10.1371/journal.pcbi.1012055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 03/05/2025] [Accepted: 01/31/2025] [Indexed: 03/01/2025] Open
Abstract
The number of new HIV infections among men who have sex with men (MSM) in the Netherlands has been decreasing, but additional efforts are required to bring it further down. This study aims to assess the impact of increased diagnosis of early HIV infection combined with immediate antiretroviral treatment (ART) initiation on reducing HIV transmission among MSM. We developed an agent-based model calibrated to HIV surveillance and sexual behavior data for MSM in the Netherlands in 2017-2022. Starting in 2023, we simulated a 10-year intervention that accelerates HIV diagnosis during the first 3 or 6 months after HIV acquisition across five levels of increased diagnosis rates (2, 4, 8, 16, and 32-fold), followed by immediate ART initiation. The upper limit of the intervention's impact over 10 years is projected to result in the cumulative 298 (95-th QI: 162-451) HIV infections averted. A 32-fold increase in the diagnosis rate within 3 months after HIV acquisition (corresponding to 100% of all new HIV infections diagnosed within 3 months of acquisition) results in 269 (95-th QI: 147-400) infections averted, approaching closely maximum impact. By extending the scope of the intervention to individuals who acquired HIV infection within the previous 6 months, a smaller 8-fold increase in the diagnosis rate (corresponding to 97% of new HIV infections diagnosed within 6 months of acquisition) approaches closely the maximum impact of the intervention by averting 256 (95-th QI: 122-411) HIV infections. Our sensitivity analyses showed that, in an epidemiological context similar to the modern-day the Netherlands, immediate initiation of ART accompanying accelerated diagnosis of individuals with early HIV infection does not significantly affect HIV transmission dynamics. Accelerating early HIV diagnosis through increased awareness, screening, and testing can further reduce transmission among MSM. Meeting this goal necessitates a stakeholder needs assessment.
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Affiliation(s)
- Alexandra Teslya
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Janneke Cornelia Maria Heijne
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Immunology & Infectious Diseases (AII), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute (APH), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Maarten Franciscus Schim van der Loeff
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Stichting HIV Monitoring, Amsterdam, The Netherlands
| | - Ard van Sighem
- Amsterdam UMC location University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Jacob Aiden Roberts
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maartje Dijkstra
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Godelieve J de Bree
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Axel Jeremias Schmidt
- Sigma Research, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Medicine and Health Policy Unit, German AIDS Federation, Berlin, Germany
| | - Kai J Jonas
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Mirjam E Kretzschmar
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Center for Complex Systems Studies (CCSS), Utrecht University, Utrecht, The Netherlands
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Ganna Rozhnova
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Center for Complex Systems Studies (CCSS), Utrecht University, Utrecht, The Netherlands
- BioISI – Biosystems & Integrative Sciences Institute, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
- Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
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Cambiano V, Miners A, Lampe FC, McCormack S, Gill ON, Hart G, Fenton KA, Cairns G, Thompson M, Delpech V, Rodger AJ, Phillips AN. The effect of combination prevention strategies on HIV incidence among gay and bisexual men who have sex with men in the UK: a model-based analysis. Lancet HIV 2023; 10:e713-e722. [PMID: 37923485 PMCID: PMC7616872 DOI: 10.1016/s2352-3018(23)00204-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND In the UK, the number of new HIV diagnoses among gay and bisexual men who have sex with men (GBMSM) has decreased substantially. We aimed to understand the contribution of different interventions in reducing HIV incidence so far; to estimate future HIV incidence with continuation of current policies and with further scaling up of current interventions; and to estimate the maximum additional annual cost that should be spent towards these interventions for them to offer value for money. METHODS We calibrated a dynamic, individual-based, stochastic simulation model, the HIV Synthesis Model, to multiple sources of data on HIV among GBMSM aged 15 years or older in the UK. Primarily these were routine HIV surveillance data collected by the UK Health Security Agency. We compared HIV incidence in 2022 with the counterfactual incidence: if HIV testing rates stopped increasing in 2012 and the policy of antiretroviral therapy (ART) at diagnosis was not introduced in mid-2015; if pre-exposure prophylaxis (PrEP) was not introduced; if condom use was low from 2012 in all GBMSM, at levels similar to those observed in 1980; and in the first and second scenario combined. We also projected future outcomes under the assumption of continuation of current policies and considering increases in PrEP and HIV testing uptake and a decrease in condomless sex. FINDINGS Our model estimated a 77% (90% uncertainty interval [UI] 61-88) decline in HIV incidence since around 2014, with an estimated 597 infections ([90% UI 312-956]; 1·1 per 1000 person-years [90% UI 0·6-1·8]) in men aged 15-64 years in 2022. Both PrEP introduction and increased HIV testing with ART initiation at diagnosis each had a substantial effect on HIV incidence. Without PrEP introduction, we estimate there would have been 2·16 times the number of infections that actually occurred (90% UI 1·06-3·75) between 2012 and 2022; without increased HIV testing and ART initiation at diagnosis there would have been 2·18 times the number of infections that actually occurred (1·18-3·60), and if condomless sex was at the levels before the HIV epidemic, there would have been 2·27 times the number of infections that actually occurred (0·9-5·4). If rates of testing, ART use, and PrEP use remain as they are currently, there is a predicted decline in incidence to 388 HIV infections in 2025 (90% UI 226-650) and to 263 (137-433) in 2030. Increases in HIV testing and PrEP use were predicted to accelerate the decline in HIV incidence. Given the quality-adjusted life-year (QALY) benefit and a cost-effectiveness threshold of £30 000 per QALY gained, in order to be cost-effective an additional £1·62 million could be spent per year to increase testing levels by 34% (90% UI 25-46) and PrEP use by 55% (10-107). To achieve that, a 16% reduction in the cost of delivery of testing and PrEP would be required. INTERPRETATION Combination prevention, including a PrEP strategy, played a major role in the reduction in HIV incidence observed so far in the UK among GBMSM. Continuation of current activities should lead to a continued decline; however, it is unlikely to lead to reaching the target of fewer than 50 HIV infections per year among GBMSM by 2030. It will be important to reduce costs for testing and PrEP for their continued expansion to be cost-effective. FUNDING National Institute for Health Research under its Programme Grants for Applied Research Programme and Medical Research Council-UK Research and Innovation.
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Affiliation(s)
| | - Alec Miners
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Fiona C Lampe
- Institute for Global Health, University College London, London, UK
| | - Sheena McCormack
- MRC Clinical Trials Unit at University College London, London, UK
| | | | - Graham Hart
- Institute for Global Health, University College London, London, UK
| | - Kevin A Fenton
- Office for Health Improvement and Disparities (London) and NHS London, London, UK
| | | | | | | | - Alison J Rodger
- Institute for Global Health, University College London, London, UK
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Long-term evolution of comorbidities and their disease burden in individuals with and without HIV as they age: analysis of the prospective AGE hIV cohort study. Lancet HIV 2023; 10:e164-e174. [PMID: 36774943 DOI: 10.1016/s2352-3018(22)00400-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 11/29/2022] [Accepted: 12/13/2022] [Indexed: 02/11/2023]
Abstract
BACKGROUND People with HIV generally have more ageing-associated comorbidities than those without HIV. We aimed to establish whether the difference in comorbidities and their disease burden changes with ageing. METHODS In this prospective, longitudinal cohort study, we assessed comorbidities commonly associated with ageing every 2 years in 596 HIV-positive and 550 HIV-negative participants. HIV-positive participants were recruited from the HIV outpatient clinic of the Amsterdam University Medical Centres (Amsterdam, Netherlands). HIV-negative participants were recruited from the sexual health clinic and the Amsterdam Cohort Studies at the Public Health Service of Amsterdam (Amsterdam, Netherlands). Inclusion criteria were participants aged 45 years or older and, for HIV-negative participants, a documented HIV-negative antibody test. The mean number of comorbidities present over time was compared between groups by use of Poisson regression, accounting for dropout and death through joint survival models. Mean disability-adjusted life-years (DALYs) accrued during 2-year intervals were compared between groups by use of an exponential hurdle model. FINDINGS Between Oct 29, 2010, and Oct 9, 2012, participants were enrolled and then prospectively followed up until their last visit before Oct 1, 2018. 1146 participants were followed up for a median 5·9 years (IQR 5·7-6·0), during which 231 participants (20·2%) dropped out: 145 (24·3%) of 596 HIV-positive and 86 (15·6%) of 550 HIV-negative. 38 (3·3%) of 1146 participants died: 31 (5·2%) of 596 HIV-positive and seven (1·3%) of 550 HIV-negative. 24 HIV-positive and two HIV-negative participants died from ageing-associated comorbidities. 15 HIV-positive participants versus one HIV-negative participant died from non-AIDS malignancies. At inclusion, mean number of comorbidities was higher in HIV-positive participants (0·65) than in HIV-negative participants (0·32; p<0·0001). Mean number of comorbidities increased at similar rates over time: rate ratio (RR) per year for HIV-positive participants 1·04 (95% CI 1·00-1·08), RR per year for HIV-negative participants 1·05 (1·01-1·08; pinteraction=0·78). Number of comorbidities was associated with an increased risk of death (hazard ratio 3·33 per additional comorbidity, 95% CI 2·27-4·88; p<0·0001). HIV-positive participants had higher increases in mean DALYs than HIV-negative participants (0·209 per year, 95% CI 0·162-0·256 vs 0·091 per year, 0·025-0·157; pinteraction=0·0045). This difference was reduced when deaths were excluded in establishing DALYs (0·127, 0·083-0·171 vs 0·066, 0·005-0·127; pinteraction =0·11). INTERPRETATION The larger comorbidity prevalence in HIV-positive participants aged 50-55 years on effective antiretroviral treatment than in HIV-negative participants increased similarly as participants aged and was associated with an increased risk of death, particularly of non-AIDS malignancies. Our findings reinforce the need for strategies to optimise prevention, screening, and early intervention. FUNDING Netherlands Organization for Health Research and Development, Aidsfonds, Gilead Sciences, ViiV Healthcare, Janssen Pharmaceuticals, and Merck & Co. TRANSLATION For the Dutch translation of the abstract see Supplementary Materials section.
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Changes in substance use among HIV-negative MSM: A longitudinal analysis, 1995-2019. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 106:103748. [PMID: 35649313 DOI: 10.1016/j.drugpo.2022.103748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 04/29/2022] [Accepted: 05/05/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Research suggests shifting patterns of recreational drug consumption among MSM in recent decades. The present study evaluates population-level mean trajectories of substance use among HIV-negative MSM from 1995 to 2019. METHODS Using open cohort study data following MSM in the Netherlands (n=1495) since 1995, we applied generalized estimating equations to examine population-averaged estimates of five substances - alcohol, cannabis, ecstasy, cocaine, and poppers - from 1995 to 2019, as well as their use during sexual encounters. RESULTS Recent alcohol use decreased; predicted probabilities declined from 1995 to 2019 (.96 to .87). During the same period, cocaine and poppers use increased - (.10 to .23 and .37 to .47, respectively) and use during sex also increased (.05 to .16, and .32 to .41, respectively). Ecstasy use increased over time (.23 to .38), although not during sex. No significant changes in cannabis use occurred. CONCLUSIONS While changes in use of various substances were mixed, increases in cocaine and poppers use during sexual encounters occurred among HIV-negative MSM over time. Efforts to intervene on substance use in connection with sex remain critical for health promotion.
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Coyer L, Boyd A, Davidovich U, van Bilsen WPH, Prins M, Matser A. Increase in recreational drug use between 2008 and 2018: results from a prospective cohort study among HIV-negative men who have sex with men. Addiction 2022; 117:656-665. [PMID: 34402120 PMCID: PMC9292014 DOI: 10.1111/add.15666] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 08/04/2021] [Indexed: 11/28/2022]
Abstract
AIMS To test whether recreational drug use (RDU) and sexualized drug use (SDU) changed in the Amsterdam area between 2008 and 2018 and quantify associations of SDU with condomless anal sex (CAS), recent human immunodeficiency virus (HIV) or sexually transmitted infections (STI) among human immunodeficiency virus (HIV)-negative men who have sex with men (MSM). DESIGN Open prospective cohort study. SETTING Public Health Service of Amsterdam, the Netherlands. PARTICIPANTS A total of 976 HIV-negative MSM, aged ≥ 18 years. MEASUREMENTS Self-reported RDU and sexual behaviour in the past 6 months. Laboratory-confirmed HIV and STI (chlamydia, gonorrhoea and syphilis). We studied: any RDU; any SDU (i.e. any RDU during sex); specific SDU (i.e. use of mephedrone, methamphetamine, gamma-hydroxybutyric acid/gamma-butyrolactone, ketamine, amphetamine, cocaine and/or ecstasy during sex); use of individual drugs; and use of individual drugs during sex. We evaluated changes over calendar years in the proportion of individuals with these end-points [using logistic regression with generalized estimating equations (GEE)] and number of drugs (using negative binomial regression with GEE), adjusted for current age, country of birth and education level. FINDINGS Median age of participants in 2008 was 33.2 years (interquartile range = 27.8-40.1); 83.1% were born in the Netherlands. The proportion of any RDU increased from 67.2% in 2008 to 69.5% in 2018 [adjusted odds ratio (aOR) = 1.25; 95% confidence interval (CI) = 1.03-1.51]. Any SDU increased from 53.8% in 2008 to 59.8% in 2013 (aOR = 1.23; 95% CI = 1.07-1.42) and remained stable afterwards. Specific SDU increased from 25.0% in 2008 to 36.1% in 2018 (aOR = 2.10; 95% CI = 1.71-2.58). The average number of drugs used increased for those reporting any RDU, any SDU and specific SDU (all P < 0.05. Among those engaging in sex, any SDU was associated with CAS (aOR = 1.36; 95% CI = 1.19-1.55), HIV (aOR = 5.86; 95% CI = 2.39-14.4) and STI (aOR = 2.31; 95% CI = 1.95-2.73). Specific SDU was associated with CAS (aOR = 1.58; 95% CI = 1.37-1.81), HIV (aOR = 6.30; 95% CI = 3.28-12.1) and STI (aOR = 2.15; 95% CI = 1.81-2.55). CONCLUSIONS Among human immunodeficiency virus (HIV)-negative men who have sex with men in Amsterdam, recreational drug use, including sexualized drug use, increased between 2008 and 2018. Sexualized drug use was strongly associated with condomless anal sex, HIV and sexually transmitted infections.
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Affiliation(s)
- Liza Coyer
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamthe Netherlands
| | - Anders Boyd
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamthe Netherlands,Stichting HIV MonitoringAmsterdamthe Netherlands
| | - Udi Davidovich
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamthe Netherlands,Department of Social PsychologyUniversity of AmsterdamAmsterdamthe Netherlands
| | - Ward P. H. van Bilsen
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamthe Netherlands
| | - Maria Prins
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamthe Netherlands,Department of Internal Medicine, Division of Infectious Diseases, Amsterdam Infection and Immunity (AII), Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Amy Matser
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamthe Netherlands
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Zheng Y, Ying M, Zhou Y, Lin Y, Ren J, Wu J. Global Burden and Changing Trend of Hepatitis C Virus Infection in HIV-Positive and HIV-Negative MSM: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2021; 8:774793. [PMID: 34966758 PMCID: PMC8710739 DOI: 10.3389/fmed.2021.774793] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The disease burden of hepatitis C virus (HCV) infection in HIV-positive and HIV-negative men who have sex with men (MSM) is changing. We aim to provide an updated comprehensive estimate of HCV prevalence and incidence among the HIV-positive and HIV-negative MSM population at the country, regional, and global levels and their changing trends over time. Methods: PubMed, Embase, PsycINFO, CINAHL, and conference databases were searched and eligible records on the prevalence and incidence of HCV antibodies were selected and pooled via a random-effects model. Meta-regression was performed to demonstrate the association between the pooled rates and study year. Results: A total of 230 articles reporting 245 records from 51 countries with 445,883 participants and 704,249 follow-up person-years were included. The pooled prevalence of HCV in MSM was 5.9% (95% CI: 5.1-6.8), with substantial differences between countries and regions. Low- and lower-middle-income countries (12.3 and 7.0%) manifested a larger disease burden than high- and upper-middle-income countries (5.8 and 3.8%). HCV prevalence in HIV-positive MSM was substantially higher than in HIV-negative MSM (8.1 vs. 2.8%, p < 0.001). The pooled incidence of HCV was 8.6 (95% CI: 7.2-10.0) per 1,000 person-years, with an increasing trend over time, according to meta-regression (p < 0.05). Conclusion: Global HCV prevalence in MSM varies by region and HIV status. Behavior counseling and regular HCV monitoring are needed in HIV-positive subgroups and high-risk regions. Given the upward trend of HCV incidence and sexual risk behaviors, there is also a continued need to reinforce risk-reduction intervention. Systematic Review Registration: PROSPERO, identifier CRD42020211028; https://www.crd.york.ac.uk/prospero/.
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Affiliation(s)
- Yang Zheng
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Department of General Practice, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Meike Ying
- Department of General Practice, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yuqing Zhou
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Department of Respiratory Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yushi Lin
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jingjing Ren
- Department of General Practice, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jie Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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9
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Basten MGJ, van Wees DA, Matser A, Boyd A, Rozhnova G, den Daas C, Kretzschmar MEE, Heijne JCM. Time for change: Transitions between HIV risk levels and determinants of behavior change in men who have sex with men. PLoS One 2021; 16:e0259913. [PMID: 34882698 PMCID: PMC8659368 DOI: 10.1371/journal.pone.0259913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/28/2021] [Indexed: 11/23/2022] Open
Abstract
As individual sexual behavior is variable over time, the timing of interventions might be vital to reducing HIV transmission. We aimed to investigate transitions between HIV risk levels among men who have sex with men (MSM), and identify determinants associated with behavior change. Participants in a longitudinal cohort study among HIV-negative MSM (Amsterdam Cohort Studies) completed questionnaires about their sexual behavior during biannual visits (2008-2017). Visits were assigned to different HIV risk levels, based on latent classes of behavior. We modelled transitions between risk levels, and identified determinants associated with these transitions at the visit preceding the transition using multi-state Markov models. Based on 7,865 visits of 767 participants, we classified three risk levels: low (73% of visits), medium (22%), and high risk (5%). For MSM at low risk, the six-month probability of increasing risk was 0.11. For MSM at medium risk, the probability of increasing to high risk was 0.08, while the probability of decreasing to low risk was 0.33. For MSM at high risk, the probability of decreasing risk was 0.43. Chemsex, erection stimulants and poppers, high HIV risk perception, and recent STI diagnosis were associated with increased risk at the next visit. High HIV risk perception and young age were associated with decreasing risk. Although the majority of MSM showed no behavior change, a considerable proportion increased HIV risk. Determinants associated with behavior change may help to identify MSM who are likely to increase risk in the near future and target interventions at these individuals, thereby reducing HIV transmission.
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Affiliation(s)
- Maartje G. J. Basten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Daphne A. van Wees
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Amy Matser
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Anders Boyd
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Stichting HIV Monitoring, Amsterdam, The Netherlands
| | - Ganna Rozhnova
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- BioISI – Biosystems & Integrative Sciences Institute, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - Chantal den Daas
- Center for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Aberdeen Health Psychology Group, Institute of Applied Health Sciences, Aberdeen, Scotland
| | - Mirjam E. E. Kretzschmar
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Janneke C. M. Heijne
- Center for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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10
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Munck HNM, Qvist T, Helleberg M, Kaye PS, Pichon F, Cowan S. At-Risk Groups of Men Who Have Sex With Men Can Be Reached Through Community-Based HIV Testing in Denmark. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2021; 33:439-449. [PMID: 34369829 DOI: 10.1521/aeap.2021.33.5.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This study evaluates whether the community-based HIV testing clinic Checkpoint could reach at-risk groups of men who have sex with men (MSM) and link patients to care. A prospective observational study of all Checkpoint visits during 2013-2016 and a retrospective registry study of all MSM diagnosed with HIV in Denmark during the same period were conducted. One percent of the 9,074 tests in Checkpoint were HIV-positive, accounting for 19% of all new HIV diagnoses among MSM in Denmark. Checkpoint testers reported frequent condomless anal sex. Two percent of migrant Checkpoint testers were HIV-positive compared to 1 % among Danish MSM. HIV-positive MSM identified through Checkpoint were significantly younger, more of them were migrant, and a smaller proportion were late testers compared to those testing through the conventional health care system. Checkpoint reaches at-risk populations of MSM and links patients successfully to care.
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Affiliation(s)
| | - Tavs Qvist
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Marie Helleberg
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Susan Cowan
- Department of Sexually Transmitted Infections and Blood-Borne Viruses, Statens Serum Institut, Copenhagen, Denmark
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11
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Trends in HIV incidence between 2013-2019 and association of baseline factors with subsequent incident HIV among gay, bisexual, and other men who have sex with men attending sexual health clinics in England: A prospective cohort study. PLoS Med 2021; 18:e1003677. [PMID: 34143781 PMCID: PMC8253400 DOI: 10.1371/journal.pmed.1003677] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 07/02/2021] [Accepted: 06/01/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Prospective cohort studies of incident HIV and associated factors among gay, bisexual, and other men who have sex with men (GBMSM) in the United Kingdom are lacking. We report time trends in and factors associated with HIV incidence between 2013 and 2019 among a cohort of GBMSM: the AURAH2 prospective study. METHODS AND FINDINGS Participants were recruited through 1 of 3 sexual health clinics in London and Brighton (July 2013 to April 2016) and self-completed a baseline paper questionnaire and subsequent 4-monthly and annual online questionnaires (March 2015 to March 2018), including information on sociodemographics, lifestyle, health and well-being, HIV status, sexual/HIV-related behaviours, and preexposure prophylaxis and postexposure prophylaxis (PrEP/PEP). Incident HIV was ascertained by linkage with national HIV surveillance data from Public Health England (PHE). We investigated the associations of HIV incidence with (1) baseline factors using mixed-effects Weibull proportional hazard models, unadjusted and adjusted for age, country of birth and ethnicity, sexuality, and education level; and (2) time-updated factors, using mixed-effects Poisson regression models. In total, 1,162 men (mean age 34 years, 82% white, 94% gay, 74% university-educated) were enrolled in the study. Thirty-three HIV seroconversions occurred over 4,618.9 person-years (PY) of follow-up: an overall HIV incidence rate (IR) of 0.71 (95% confidence interval (CI) 0.51 to 1.00) per 100 PY. Incidence declined from 1.47 (95% CI 0.48 to 4.57) per 100 PY in 2013/2014 to 0.25 (95% CI 0.08 to 0.78) per 100 PY in 2018/2019; average annual decline was 0.85-fold (p < 0.001). Baseline factors associated with HIV acquisition included the following: injection drug use (6/38 men who reported injection drug-acquired HIV; unadjusted conditional hazard ratio (HR) 27.96, 95% CI 6.99 to 111.85, p < 0.001), noninjection chemsex-related drug use (13/321; HR 6.45, 95% CI 1.84 to 22.64, p < 0.001), condomless anal sex (CLS) (26/741; HR 3.75, 95% CI 1.31 to 10·74, p = 0.014); higher number of CLS partners (HRs >10 partners [7/57]; 5 to 10 partners [5/60]; and 2 to 4 partners [11/293]: 14.04, 95% CI 4.11 to 47.98; 9.60, 95% CI 2.58 to 35.76; and 4.05, 95% CI 1.29 to 12.72, respectively, p < 0.001); CLS with HIV-positive partners (14/147; HR 6.45, 95% CI 3.15 to 13.22, p < 0.001), versatile CLS role (21/362; HR 6.35, 95% CI 2.18 to 18.51, p < 0.001), group sex (64/500; HR 8.81, 95% CI 3.07 to 25.24, p < 0.001), sex for drugs/money (4/55, HR 3.27, 95% CI 1.14 to 9.38, p = 0.027) (all in previous 3 months); previous 12-month report of a bacterial sexually transmitted infection (STI) diagnoses (21/440; HR 3.95, 95% CI 1.81 to 8.63, p < 0.001), and more than 10 new sexual partners (21/471, HRs 11 to 49, 50 to 99, and >100 new partners: 3.17, 95% CI 1.39 to 7.26; 4.40, 95% CI 1.35 to 14.29; and 4.84, 95% CI 1.05 to 22.4, respectively, p < 0.001). Results were broadly consistent for time-updated analysis (n = 622 men). The study's main limitation is that men may not be representative of the broader GBMSM population in England. CONCLUSIONS We observed a substantial decline in HIV incidence from 2013 to 2019 among GBMSM attending sexual health clinics. Injection drug use, chemsex use, and measures of high-risk sexual behaviour were strongly associated with incident HIV. Progress towards zero new infections could be achieved if combination HIV prevention including Test and Treat strategies and routine commissioning of a PrEP programme continues across the UK and reaches all at-risk populations.
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12
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Basten M, den Daas C, Heijne JCM, Boyd A, Davidovich U, Rozhnova G, Kretzschmar M, Matser A. The Rhythm of Risk: Sexual Behaviour, PrEP Use and HIV Risk Perception Between 1999 and 2018 Among Men Who Have Sex with Men in Amsterdam, The Netherlands. AIDS Behav 2021; 25:1800-1809. [PMID: 33269426 PMCID: PMC8081694 DOI: 10.1007/s10461-020-03109-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 11/14/2022]
Abstract
HIV risk perception plays a crucial role in the uptake of preventive strategies. We investigated how risk perception and its determinants changed between 1999 and 2018 in an open, prospective cohort of 1323 HIV-negative men who have sex with men (MSM). Risk perception, defined as the perceived likelihood of acquiring HIV in the past 6 months, changed over time: being relatively lower in 2008–2011, higher in 2012–2016, and again lower in 2017–2018. Irrespective of calendar year, condomless anal intercourse (AI) with casual partners and high numbers of partners were associated with higher risk perception. In 2017–2018, condomless receptive AI with a partner living with HIV was no longer associated with risk perception, while PrEP use and condomless AI with a steady partner were associated with lower risk perception. We showed that risk perception has fluctuated among MSM in the past 20 years. The Undetectable equals Untransmittable statement and PrEP coincided with lower perceived risk.
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13
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Verboeket SO, Boyd A, Wit FW, Verheij E, Schim van der Loeff MF, Kootstra N, van der Valk M, van Steenwijk RP, Drummond MB, Kirk GD, Reiss P. Changes in lung function among treated HIV-positive and HIV-negative individuals: analysis of the prospective AGEhIV cohort study. THE LANCET. HEALTHY LONGEVITY 2021; 2:e202-e211. [DOI: 10.1016/s2666-7568(21)00033-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/16/2021] [Accepted: 02/16/2021] [Indexed: 12/25/2022] Open
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14
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Knox J, Boyd A, Matser A, Heijman T, Sandfort T, Davidovich U. Types of Group Sex and Their Association with Different Sexual Risk Behaviors Among HIV-Negative Men Who Have Sex with Men. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:1995-2003. [PMID: 32500245 PMCID: PMC7321909 DOI: 10.1007/s10508-020-01744-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/26/2020] [Accepted: 05/15/2020] [Indexed: 06/11/2023]
Abstract
The current study sought to identify types of group sex acts among HIV-negative men who have sex with men (MSM) and assess their association with different sexual risk behaviors using cross-sectional data of group sex acts reported during 6 waves (2015-2018) of the Amsterdam MSM Cohort Study. Latent class analysis was performed to identify group sex types based on size, familiarity with partners, location, planning, and drug use. Associations between group sex types and sexual behaviors were evaluated using logistic regression with generalized estimating equations, employing the sample mean as a reference. Data at the level of group sex acts were analyzed, while correcting variance estimations for repeated measurements within MSM. A total of 392 MSM engaged in group sex ≥ 1 times, totaling 1033 group sex acts. Four types of group sex emerged: familiar (29%), intimate (27%), impromptu (36%), and party (8%). Familiar group sex (characterized by high proportions of mostly known partners, occurring in private places and involving drug use) had an increased adjusted odds of risky fingering (aOR 1.6, 95%CI 1.3-2.0) and of risky fisting and/or use of sex toys (aOR 2.3, 95%CI 1.6-3.1). Intimate group sex (characterized by high proportions of threesomes, occurring in private places, and not involving drug use) had a decreased adjusted odds of risky fisting and/or use of sex toys (aOR 0.6, 95%CI 0.4-0.9). Impromptu group sex (characterized by high proportions of spontaneity, mostly unknown partners, and taking place in public places) had a decreased adjusted odds of risky fisting and/or use of sex toys (aOR 0.5, 95%CI 0.3-0.7) and of condomless anal intercourse (CAI) (OR 0.6, 95%CI 0.5-0.8). Party group sex (characterized by high proportions of larger groups, mostly unknown partners, and being planned) had an increased adjusted odds of risky fisting and/or use of sex toys (aOR 1.6, 95%CI 1.0-2.7) and of CAI (aOR 1.5, 95%CI 1.1-2.1). The identified types of group sex reflect different dynamics and characteristics, with some types riskier for STIs and others riskier for HIV. HIV and STI prevention efforts could be tailored accordingly. For example, in certain type of public sex environments (e.g., cruising parks), traditional HIV and STI prevention efforts, such as promoting of condom use and PrEP, might be sufficient. However, in other settings (e.g., private parties), where group sex is more likely to be planned and where behaviors such as fisting, sharing of sex toys, and CAI are more likely to take place, which carry different levels of risk for HIV and STI transmission, including that of Hepatitis C, different approaches might be needed, such as broader HIV and STI prevention education efforts or targeting the organizers of group sex events.
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Affiliation(s)
- Justin Knox
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, 10032, USA.
| | - Anders Boyd
- Department of Infectious Diseases Research and Prevention, Public Health Service Amsterdam, Amsterdam, The Netherlands
- Stichting HIV Monitoring, Amsterdam, The Netherlands
| | - Amy Matser
- Department of Infectious Diseases Research and Prevention, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Titia Heijman
- Department of Infectious Diseases Research and Prevention, Public Health Service Amsterdam, Amsterdam, The Netherlands
- Department of Infectious Diseases, STI Outpatient Clinic, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Theo Sandfort
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Udi Davidovich
- Department of Infectious Diseases Research and Prevention, Public Health Service Amsterdam, Amsterdam, The Netherlands
- Department of Social Psychology, University of Amsterdam, Amsterdam, The Netherlands
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15
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Kruize Z, Maurer I, van Dort KA, van den Elshout MAM, Hoornenborg E, Booiman T, Prins M, Kootstra NA. Human Immunodeficiency Virus-Negative Men Who Have Sex With Men Have an Altered T-Cell Phenotype and Bioenergy Metabolism. Open Forum Infect Dis 2020; 7:ofaa284. [PMID: 32782910 PMCID: PMC7408207 DOI: 10.1093/ofid/ofaa284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/01/2020] [Indexed: 11/17/2022] Open
Abstract
Background We recently reported that the levels of activation, exhaustion, and terminal differentiation within the peripheral T-cell compartment were increased in men who have sex with men (MSM) compared with blood bank donors. During activation and differentiation, T cells undergo metabolic changes to maintain their energy demand. Methods The effect of cytomeglovirus (CMV) infection and risk behavior on the immune phenotype of peripheral T cells and the immune bioenergy metabolism profile in human immunodeficiency virus-negative MSM (with high or low sexual risk behavior) and blood bank donors was evaluated. Results Men who have sex with men exhibited increased levels of T-cell activation and terminal differentiation and an impairment of the bioenergy metabolism (mitochondrial respiration and glycolysis) compared with blood bank donors. Cytomeglovirus infection was associated with increased terminal differentiation of CD4+ (B = 3.41; 95% confidence interval [CI], 1.98–4.85; P < .0001) and CD8+ T cells (CD57+: B = 1.21, 95% CI = 0.41–2.02, P = .004; CD27−CD28−: B = 2.20, 95% CI = 1.21–3.18, P < .0001; and CD57+ of CD28−: B = 1.02, 95% CI = 0.38–1.66, P = .002) and increased glycolysis (B = 0.97; 95% CI, 0.27–1.67; P = .007). Risk behavior was associated with increase activation of CD4+ T cells (B = 0.22; 95% CI, 0.07–0.37; P = .005), increased terminal differentiation of CD4+ (B = 0.82; 95% CI, 0.44–1.20; P < .0001) and CD8+ T cells (B = 1.55; 95% CI, 0.58–2.51; P = .002), and decreased glycolysis (glycolysis: B = −0.40, 95% CI = −0.68 to 0.12, P = .006; and glycolytic capacity: B = −0.54, 95% CI = −0.91 to 0.16, P = .005). Conclusions Men who have sex with men show an increased prevalence of bloodborne and sexually transmitted infection, indicating that immunological changes in the T-cell population and the bioenergy metabolism observed in MSM can most likely be attributed to chronic antigen exposure.
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Affiliation(s)
- Zita Kruize
- Department of Experimental Immunology, Amsterdam UMC, Amsterdam Infection & Immunity Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Irma Maurer
- Department of Experimental Immunology, Amsterdam UMC, Amsterdam Infection & Immunity Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Karel A van Dort
- Department of Experimental Immunology, Amsterdam UMC, Amsterdam Infection & Immunity Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Mark A M van den Elshout
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Elske Hoornenborg
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Thijs Booiman
- Department of Experimental Immunology, Amsterdam UMC, Amsterdam Infection & Immunity Institute, University of Amsterdam, Amsterdam, the Netherlands.,Halix, Leiden, the Netherlands
| | - Maria Prins
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands.,Department of Infectious Diseases, Amsterdam UMC, Amsterdam Infection & Immunity Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Neeltje A Kootstra
- Department of Experimental Immunology, Amsterdam UMC, Amsterdam Infection & Immunity Institute, University of Amsterdam, Amsterdam, the Netherlands
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16
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van Bilsen WPH, Zaaijer HL, Matser A, van den Hurk K, Slot E, Schim van der Loeff MF, Prins M, van de Laar TJW. Infection Pressure in Men Who Have Sex With Men and Their Suitability to Donate Blood. Clin Infect Dis 2020; 68:1001-1008. [PMID: 30052873 DOI: 10.1093/cid/ciy596] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 07/24/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Deferral of men who have sex with men (MSM) from blood donation is highly debated. We therefore investigated their suitability to donate blood. METHODS We compared the antibody prevalence of 10 sexually and transfusion-transmissible infections (TTIs) among 583 MSM and 583 age-matched repeat male blood donors. MSM were classified as low risk (lr) or medium-to-high risk (hr) based on self-reported sexual behavior and as qualified or unqualified using Dutch donor deferral criteria. Infection pressure (IP) was defined as the number of antibody-reactive infections, with class A infections (human immunodeficiency virus-1/2, hepatitis B virus, hepatitis C virus, human T-cell lymphotropic virus-1/2, syphilis) given double weight compared to class B infections (cytomegalovirus, herpes simplex virus-1/2, human herpesvirus 8, hepatitis E virus, parvovirus B19). RESULTS Donors had a lower median IP than qualified lr-MSM and qualified hr-MSM (2 [interquartile range {IQR}, 1-2] vs 3 [IQR, 2-4]; P < .001). Low IP was found in 76% of donors, 39% of qualified lr-MSM, and 27% of qualified hr-MSM. The prevalence of class A infections did not differ between donors and qualified lr-MSM but was significantly higher in qualified hr-MSM and unqualified MSM. Recently acquired class A infections were detected in hr-MSM only. Compared to blood donors, human herpesviruses were more prevalent in all MSM groups (P < .001). CONCLUSIONS IP correlates with self-reported risk behavior among MSM. Although lr-MSM might form a low threat for blood safety with regard to class A infections, the high seroprevalence of human herpesviruses in lr-MSM warrants further investigation.
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Affiliation(s)
- Ward P H van Bilsen
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Hans L Zaaijer
- Department of Blood-borne Infections, Sanquin Research, Amsterdam, The Netherlands.,Department of Internal Medicine, Amsterdam Infection and Immunity Institute, Academic Medical Center, Amsterdam, The Netherlands
| | - Amy Matser
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Katja van den Hurk
- Department of Donor Studies, Sanquin Research, Amsterdam, The Netherlands
| | - Ed Slot
- Department of Blood-borne Infections, Sanquin Research, Amsterdam, The Netherlands
| | - Maarten F Schim van der Loeff
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands.,Department of Internal Medicine, Amsterdam Infection and Immunity Institute, Academic Medical Center, Amsterdam, The Netherlands
| | - Maria Prins
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands.,Department of Internal Medicine, Amsterdam Infection and Immunity Institute, Academic Medical Center, Amsterdam, The Netherlands
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17
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Diverging trends in incidence of HIV versus other sexually transmitted infections in HIV-negative MSM in Amsterdam. AIDS 2020; 34:301-309. [PMID: 31714354 DOI: 10.1097/qad.0000000000002417] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES We investigated changes in incidence rates of HIV and sexually transmitted infections (STIs) and trends in sexual behavior in MSM from 2009 to 2017. DESIGN Open prospective cohort study. METHODS HIV-negative MSM enrolled in the Amsterdam Cohort Studies were included. Participants semiannually completed a questionnaire on sexual behavior and were tested for HIV-1, syphilis, and urethral, anal and pharyngeal chlamydia and gonorrhea. Time trends in incidence rates were analyzed using exponential survival models. RESULTS During follow-up, 42 of 905 MSM acquired HIV. The HIV incidence rate was 1.9/100 person-years [95% confidence interval (CI) 1.0-3.7] in 2009 and decreased to 0.5/100 person-years (95% CI 0.2-1.4) in 2017 (P = 0.03). The largest decrease was observed in participants aged at least 35 years (P = 0.005), while the trend remained stable in 18-34 year olds (P = 0.4). The incidence rate for any bacterial STI was 16.8/100 person-years (95% CI 13.4-21.0) in 2010, and increased to 33.1/100 person-years (95% CI 29.0-37.9) in 2017 (P < 0.001). Between 2009 and 2017, the percentage reporting condomless anal sex with casual partners increased from 26.9 to 39.4% (P < 0.001), and the mean number of casual partners from eight (95% CI 8-8) to 11 (95% CI 10-11) (P = 0.05). Condomless anal sex with steady partner(s) remained stable over time (P = 0.5). CONCLUSION Among MSM in Amsterdam, incidence rates of HIV versus other STI show diverging trends. The increase in STI incidence coincides with a decrease in condom use with casual partners. The decrease in HIV incidence, despite increased sexual risk behavior, suggests that other HIV prevention methods have been successful in reducing HIV transmission among MSM.
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18
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Verboeket SO, Wit FW, Verheij E, van Zoest RA, Kootstra NA, van der Valk M, Prins JM, Schim van der Loeff MF, Reiss P. HIV-negative Men Who Have Sex with Men have higher CD8+ T-cell Counts and Lower CD4+/CD8+ T-cell Ratios compared to HIV-negative Heterosexual Men. J Infect Dis 2020; 224:1187-1197. [PMID: 32003801 PMCID: PMC8514179 DOI: 10.1093/infdis/jiaa048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 01/30/2020] [Indexed: 02/06/2023] Open
Abstract
Background We previously reported T-cell senescence to be similar in people with human immunodeficiency virus (PWH) with suppressed viremia (predominantly men who have sex with men [MSM]) and human immunodeficiency virus (HIV)-negative otherwise comparable controls but greater than in healthy blood donors. This led us to compare CD4+ and CD8+ T-cell counts and CD4+/CD8+ ratios between HIV-negative MSM and men who only have sex with women (MSW) and relate observed differences in behavioral factors and infectious exposures, including cytomegalovirus (CMV) infection. Methods In 368 HIV-negative MSM and 72 HIV-negative MSW, T lymphocyte phenotyping was performed 3 times biennially. Baseline CMV serology and sexually transmitted infection (STI) incidence and/or STI seroprevalence, sexual, and substance-use behavior data were collected during study visits. Results Men who have sex with men, compared with MSW, had higher CD8+ counts (551 vs 437 cells/mm3, P < .001), similar CD4+ counts (864 vs 880 cells/mm3, P = .5), and lower CD4+/CD8+ ratios (1.84 vs 2.47, P < .001). Differences were most pronounced for MSM with >10 recent sex partners and partly explained by higher CMV seroprevalence in MSM. Conclusions These findings suggest that factors other than HIV may, in both PWH and certain HIV-negative MSM, contribute to a low CD4+/CD8+ ratio. Whether this, like in PWH, contributes to comorbidity risk in HIV-negative MSM requires further study.
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Affiliation(s)
- Sebastiaan O Verboeket
- Amsterdam UMC, University of Amsterdam, Departments of Global Health and Internal Medicine, Amsterdam Infection and Immunity Institute and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.,Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
| | - Ferdinand W Wit
- Amsterdam UMC, University of Amsterdam, Departments of Global Health and Internal Medicine, Amsterdam Infection and Immunity Institute and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.,Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands.,HIV Monitoring Foundation, Amsterdam, the Netherlands
| | - Eveline Verheij
- Amsterdam UMC, University of Amsterdam, Departments of Global Health and Internal Medicine, Amsterdam Infection and Immunity Institute and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.,Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
| | - Rosan A van Zoest
- Amsterdam UMC, University of Amsterdam, Departments of Global Health and Internal Medicine, Amsterdam Infection and Immunity Institute and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.,Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
| | - Neeltje A Kootstra
- Amsterdam UMC, University of Amsterdam, Department of Experimental Immunology, Amsterdam Infection & Immunity Institute, Amsterdam, the Netherlands
| | - Marc van der Valk
- Amsterdam UMC, University of Amsterdam, Departments of Global Health and Internal Medicine, Amsterdam Infection and Immunity Institute and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Jan M Prins
- Amsterdam UMC, University of Amsterdam, Departments of Global Health and Internal Medicine, Amsterdam Infection and Immunity Institute and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Maarten F Schim van der Loeff
- Amsterdam UMC, University of Amsterdam, Departments of Global Health and Internal Medicine, Amsterdam Infection and Immunity Institute and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.,Public Health Service of Amsterdam, Department of Infectious Diseases, Amsterdam, the Netherlands
| | - Peter Reiss
- Amsterdam UMC, University of Amsterdam, Departments of Global Health and Internal Medicine, Amsterdam Infection and Immunity Institute and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.,Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands.,HIV Monitoring Foundation, Amsterdam, the Netherlands
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19
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Jiang Y, Su S, Borné Y. A meta-analysis of the efficacy of HAART on HIV transmission and its impact on sexual risk behaviours among men who have sex with men. Sci Rep 2020; 10:1075. [PMID: 31974510 PMCID: PMC6978405 DOI: 10.1038/s41598-019-56530-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 11/04/2019] [Indexed: 11/23/2022] Open
Abstract
Evidence showed preventive impacts of the highly active antiretroviral therapy (HAART) on the Human Immunodeficiency Virus (HIV) transmission amomg heterosexual population, however, that is of deficit among men who have sex with men (MSM). The aim was to systematically examine the efficacy of HAART on HIV transmission and the association between the HAART initiation and unprotected anal intercourse (UAI) in MSM population. Three electronic databases were fully searched for articles published in peer-reviewed journals between 1996 and 2017. Of 1616 identified articles, fifteen articles were eligible for meta-analyses. The summary incidence rate (IR) of HIV was 6.63/100 person-year (95%CI 2.06–11.20/100 person-year)(p = 0.004). The pooled per-contact rate (PCR) of HIV was 0.42% (95% CI 0.21–0.63%)(p < 0.05). The HAART initiation (vs non-HAART) was not associated with engaging in UAI, with odds ratio (OR) 1.09 (95% CI 0.90–1.34)(p > 0.05). In the stratified analysis, participants with no less than 6 months recall period was slightly more likely to engage in UAI (OR 1.32; 95% CI 1.01–1.74)(p < 0.05). It indicated that HAART has potential efficacy on reducing infectivity of HIV positive individuals in anal intercourses. The relationship between the HAART initiation and UAI was not significant and may be influenced by some social-demographic factors. Consistent condom use and education on safe sex among MSM are crucial.
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Affiliation(s)
- Ying Jiang
- Department of Clinical Sciences in Malmö, Faculty of Medicine, Lund University, Lund, Sweden.
| | - Shu Su
- School of public health and preventive medicine, Monash University, Melbourne, Australia
| | - Yan Borné
- Department of Clinical Sciences in Malmö, Faculty of Medicine, Lund University, Lund, Sweden
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20
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Eluwa GIE, Adebajo SB, Eluwa T, Ogbanufe O, Ilesanmi O, Nzelu C. Rising HIV prevalence among men who have sex with men in Nigeria: a trend analysis. BMC Public Health 2019; 19:1201. [PMID: 31477073 PMCID: PMC6721282 DOI: 10.1186/s12889-019-7540-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 08/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Men who have sex with men (MSM) are conservatively estimated to be less than 1% of the Nigerian population yet nationally account for about 20% of new HIV infection. We estimated the trend in HIV prevalence and determined correlates of HIV infection among MSM. METHODS This study used data from respondent-driven sampling in three rounds of integrated biological and behavioral surveillance survey (2007, 2010 and 2014) and covered three states in 2007, six states in 2010 and eight states in 2014. Each round used similar methodology and thus allows for comparison. Behavioral data were obtained using a structured pre-coded questionnaire. Differences in categorical variables were assessed with Chi Square. Logistic regression was used to identify factors associated with HIV. RESULTS A total of 879, 1545 and 3611 MSM were recruited in 2007, 2010 and 2014 respectively. Median age was 22 years for 2007 and 2014 while it was 24 years in 2010. About one-third of MSM in 2007 and 2014 and about two-fifths in 2010 had engaged in transactional sex. HIV prevalence increased from 14% in 2007 to 17% in 2010 to 23% in 2014 (p < 0.0001). Factors associated with HIV include older age ≥ 25 years (adjusted odds ratio {AOR}:2.41; 95% CI:1.84-3.16); receptive anal sex (AOR:1.92; 95% CI:1.54-2.40) and history of sexually transmitted infections (AOR:1.26; 95% CI:1.02-1.55). CONCLUSION There's been a consistent and significant increase in HIV prevalence among MSM with about 10-percentage points relative increase per year over 7 years. Older MSM were more likely to be HIV positive and this may reflect their prolonged exposure to high risk sexual activities. Evidence based interventions are urgently needed to mitigate intra-group HIV transmission and propagation of HIV epidemic between MSM and the general population.
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Affiliation(s)
- George I E Eluwa
- Population Council, No. 16, Mafemi Crescent, Utako, Abuja, Nigeria.
| | - Sylvia B Adebajo
- Population Council, No. 16, Mafemi Crescent, Utako, Abuja, Nigeria
| | | | - Obinna Ogbanufe
- Centers for Disease Prevention and Control, United States Embassy, Abuja, Plot 1038 Diplomatic Drive, Abuja, Nigeria
| | - Oluwafunke Ilesanmi
- HIV and Viral Hepatitis Communicable Diseases Cluster, World Health Organization Country Office, Abuja, Nigeria
| | - Charles Nzelu
- National AIDS and STI Control Program, Federal Ministry of Health, Abuja, Nigeria
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21
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Stahlman S, Lyons C, Sullivan PS, Mayer KH, Hosein S, Beyrer C, Baral SD. HIV incidence among gay men and other men who have sex with men in 2020: where is the epidemic heading? Sex Health 2019; 14:5-17. [PMID: 27491699 DOI: 10.1071/sh16070] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 06/07/2016] [Indexed: 12/19/2022]
Abstract
The goal to effectively prevent new HIV infections among gay, bisexual, and other men who have sex with men (MSM) is more challenging now than ever before. Despite declines in the late 1990s and early 2000s, HIV incidence among MSM is now increasing in many low- and high-income settings including the US, with young, adolescent, and racial/ethnic minority MSM being among those at highest risk. Potentiating HIV risks across all settings are individual-, network-, and structural-level factors such as stigma and lack of access to pre-exposure prophylaxis (PrEP) and antiretroviral treatment as prevention. To make a sustained impact on the epidemic, a concerted effort must integrate all evidence-based interventions that will most proximally decrease HIV acquisition and transmission risks, together with structural interventions that will support improved coverage and retention in care. Universal HIV treatment, increased access to HIV testing, and daily oral PrEP have emerged as integral to the prevention of HIV transmission, and such efforts should be immediately expanded for MSM and other populations disproportionately affected by HIV. Respect for human rights and efforts to combat stigma and improve access to prevention services are needed to change the trajectory of the HIV pandemic among MSM.
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Affiliation(s)
- Shauna Stahlman
- Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Department of Epidemiology, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Carrie Lyons
- Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Department of Epidemiology, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA
| | - Kenneth H Mayer
- Fenway Health, The Fenway Institute, 1340 Boylston Street, 8th floor, Boston, MA 02215, USA
| | - Sean Hosein
- CATIE (Canada's AIDS Treatment Information Exchange), 555 Richmond Street West, Suite 505, Box 1104, Toronto, ON M5V 3B1, Canada
| | - Chris Beyrer
- Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Department of Epidemiology, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Stefan D Baral
- Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Department of Epidemiology, 615 N. Wolfe Street, Baltimore, MD 21205, USA
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22
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Borena W, Kruis S, Kitchen M, Taylor N, Gisinger M, Oberkofler H, Stoiber H, Zangerle R, von Laer D, Sarcletti M. Anal Ureaplasma spp. positivity among HIV positive men who have sex with men may be associated with high-risk-type HPV infections. Int J Infect Dis 2019; 84:75-79. [PMID: 31054966 DOI: 10.1016/j.ijid.2019.04.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/12/2019] [Accepted: 04/24/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE HIV positive individuals, particularly men having sex with men (MSM), are at increased risk of sexually transmitted infections (STIs) at genital and extra-genital sites. Data on anorectal Ureaplasma infections are lacking. The aim of our study was to characterize anal Ureaplasma positivity among a cohort of HIV positive MSM and evaluate possible association with papillomavirus infection at the same site. METHODS Anal swab samples, collected as part of routine screening for Chlamydia trachomatis and Neisseria gonorrhea, were additionally tested for HPV genotypes as well as for Ureaplasma and Mycoplasma using nucleic acid amplification method. RESULTS Out of a total of 222 study participants, 195 (89%, 95% CI (84.9-93.2)) were positive for HPV, approximately three quarter being high-risk genotypes. Forty three individuals (19.4%, 95% CI (14.4-24.3)) harbored Ureaplasma spp. Infection with high-risk HPV types was significantly associated with co-presence of Ureaplasma with an odds ratio (95% confidence-interval) of 2.59 (1.03-6.54), P = 0.04. CONCLUSION Besides a high predominance of HPV infection, asymptomatic HIV positive MSM had a high prevalence of anal Ureaplasma positivity. Concomitant infections with high-risk HPV genotypes were common and statistically significant. The role of this co-existence as a potential risk factor for anal carcinogenesis needs further elucidation.
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Affiliation(s)
- Wegene Borena
- Division of Virology, Medical University Innsbruck, Austria.
| | - Simon Kruis
- Division of Virology, Medical University Innsbruck, Austria
| | - Maria Kitchen
- Department of Dermatology and Venerology, Medical University Innsbruck, Austria
| | - Ninon Taylor
- Department of Internal Medicine (III), Paracelsus Medical University Salzburg, Austria
| | - Martin Gisinger
- Department of Dermatology and Venerology, Medical University Innsbruck, Austria
| | - Hannes Oberkofler
- Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Austria
| | | | - Robert Zangerle
- Department of Dermatology and Venerology, Medical University Innsbruck, Austria
| | | | - Mario Sarcletti
- Department of Dermatology and Venerology, Medical University Innsbruck, Austria
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23
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Impact of sexual trajectories of men who have sex with men on the reduction in HIV transmission by pre-exposure prophylaxis. Epidemics 2019; 28:100337. [PMID: 31126778 DOI: 10.1016/j.epidem.2019.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 03/08/2019] [Accepted: 03/08/2019] [Indexed: 11/23/2022] Open
Abstract
Changes in sexual risk behavior over the life course in men who have sex with men (MSM) can influence population-level intervention efficacy. Our objective was to investigate the impact of incorporating sexual trajectories describing long-term changes in risk levels on the reduction in HIV prevalence by pre-exposure prophylaxis (PrEP) among MSM. Based on the Amsterdam Cohort Study data, we developed two models of HIV transmission in a population stratified by sexual behavior. In the first model, individuals were stratified into low, medium and high risk levels and did not change their risk levels. The second model had the same stratification but incorporated additionally three types of sexual behavior trajectories. The models assumed universal antiretroviral treatment of HIV+ MSM, and PrEP use by high risk HIV- MSM. We computed the relative reduction in HIV prevalence in both models for annual PrEP uptakes of 10% to 80% at different time points after PrEP introduction. We then investigated the impact of sexual trajectories on the effectiveness of PrEP intervention. The impact of sexual trajectories on the overall prevalence and prevalence in individuals at low, medium and high risk levels varied with PrEP uptake and time after PrEP introduction. Compared to the model without sexual trajectories, the model with trajectories predicted a higher impact of PrEP on the overall prevalence, and on the prevalence among the medium and high risk individuals. In low risk individuals, there was more reduction in prevalence during the first 15 years of PrEP intervention if sexual trajectories were not incorporated in the model. After that point, at low risk level there was more reduction in the model with trajectories. In conclusion, our study predicts that sexual trajectories increase the estimated impact of PrEP on reducing HIV prevalence when compared to a population where risk levels do not change.
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24
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Bom RJM, van der Linden K, Matser A, Poulin N, Schim van der Loeff MF, Bakker BHW, van Boven TF. The effects of free condom distribution on HIV and other sexually transmitted infections in men who have sex with men. BMC Infect Dis 2019; 19:222. [PMID: 30832608 PMCID: PMC6399837 DOI: 10.1186/s12879-019-3839-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 02/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV and other sexually transmitted infections remain a burden on men who have sex with men in the era of effective combination antiretroviral therapy. New prevention efforts are therefore needed. One of these approaches is the current country-wide free condom distribution at gay bars with darkrooms and gay saunas in the Netherlands. This study assessed the effects of free condom distribution on incidence and burden of disease of HIV and other sexually transmitted infections. METHODS A static model was constructed to calculate the impact of free condom distribution on HIV, hepatitis C, chlamydia, gonorrhoea, and syphilis among men who have sex with men visiting these venues. Outcomes included new infections averted and disability-adjusted life years averted. Scenario studies were performed to predict the effects of a further increase of condom use, condom effectiveness and coverage. Lastly, cost-effectiveness and sensitivity analyses were performed. RESULTS Our model showed that condom use at public sex venues increased after the intervention. Annual incidence risk decreased, ranging from 5.73% for gonorrhoea to 7.62% for HIV. The annual number of new infections averted was largest for chlamydia and gonorrhoea (261 and 394 infections, respectively), but 42 new HIV infections were averted as well. In scenarios where condom use and condom effectiveness were further increased, the number of infections reduced more extensively. Over 99% of the decrease in burden of disease was due to HIV. The intervention was cost-effective and cost-saving (for every €1 spent on condom distribution, €5.51 was saved) and remained this in all sensitivity analyses. CONCLUSIONS Free condoms at public sex venues could reduce the transmission of HIV and other sexually transmitted infections. Condom distribution is an affordable and easily implemented intervention that could reduce the burden of disease in men who have sex with men substantially.
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Affiliation(s)
| | | | - Amy Matser
- Department of Research, Cluster of Infectious Diseases, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, the Netherlands.,Julius Center for Health Sciences & Primary Care, University Medical Center Utrecht (UMCU), Utrecht University (UU), Utrecht, the Netherlands
| | - Nicolas Poulin
- Centre de Statistique de Strasbourg (CeStatS), Institut de Recherche Mathématique Avancée (IRMA, UMR 7501), Université de Strasbourg & Centre National de la Recherche Scientifique (CNRS), Strasbourg, France
| | - Maarten F Schim van der Loeff
- Department of Research, Cluster of Infectious Diseases, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, the Netherlands.,Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, the Netherlands
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25
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Elimination prospects of the Dutch HIV epidemic among men who have sex with men in the era of preexposure prophylaxis. AIDS 2018; 32:2615-2623. [PMID: 30379687 PMCID: PMC6221378 DOI: 10.1097/qad.0000000000002050] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objective: Preexposure prophylaxis (PrEP) is a promising intervention to help end the HIV epidemic among men who have sex with men (MSM) in the Netherlands. We aimed to assess the impact of PrEP on HIV prevalence in this population and to determine the levels of PrEP coverage necessary for HIV elimination. Design and methods: We developed a mathematical model of HIV transmission in a population stratified by sexual risk behavior with universal antiretroviral treatment (ART) and daily PrEP use depending on an individual's risk behavior. We computed the effective reproduction number, HIV prevalence, ART and PrEP coverage for increasing ART and PrEP uptake levels, and examined how these were affected by PrEP effectiveness and duration of PrEP use. Results: At current levels of ART coverage of 80%, PrEP effectiveness of 86% and PrEP duration of 5 years, HIV elimination required 82% PrEP coverage in the highest risk group (12 000 MSM with more than 18 partners per year). If ART coverage increased by 9%, the elimination threshold was at 70% PrEP coverage. For shorter PrEP duration and lower effectiveness elimination prospects were less favorable. For the same number of PrEP users distributed among two groups with highest risk behavior, prevalence dropped from the current 8 to 4.6%. Conclusion: PrEP for HIV prevention among MSM could, in principle, eliminate HIV from this population in the Netherlands. The highest impact of PrEP on prevalence was predicted when ART and PrEP coverage increased simultaneously and PrEP was used by the highest risk individuals.
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26
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Verboeket SO, Wit FW, Kirk GD, Drummond MB, van Steenwijk RP, van Zoest RA, Nellen JF, Schim van der Loeff MF, Reiss P, Reiss P, Wit FWNM, van der Valk M, Schouten J, Kooij KW, van Zoest RA, Verheij E, Verboeket SO, Elsenga BC, Prins M, van der Loeff MFS, del Grande L, Olthof V, Dijkstra M, Zaheri S, Hillebregt MMJ, Ruijs YMC, Benschop DP, el Berkaoui A, Kootstra NA, Harskamp-Holwerda AM, Maurer I, Mangas Ruiz MM, Girigorie AF, Boeser-Nunnink B, Zikkenheiner W, Janssen FR, Geerlings SE, Goorhuis A, Hovius JWR, Nellen FJB, van der Poll T, Prins JM, Reiss P, van der Valk M, Wiersinga WJ, van Vugt M, de Bree G, van Eden J, van Hes AMH, Pijnappel FJJ, Weijsenfeld A, Smalhout S, van Duinen M, Hazenberg A, Postema PG, Bisschop PHLT, Serlie MJM, Lips P, Dekker E, van der Velde N, Willemsen JMR, Vogt L, Schouten J, Portegies P, Schmand BA, Geurtsen GJ, Verbraak FD, Demirkaya N, Visser I, Schadé A, Nieuwkerk PT, Langebeek N, van Steenwijk RP, Dijkers E, Majoie CBLM, Caan MWA, van Lunsen HW, Nievaard MAF, van den Born BJH, Stroes ESG, Mulder WMC, van Oorspronk S. Reduced Forced Vital Capacity Among Human Immunodeficiency Virus-Infected Middle-Aged Individuals. J Infect Dis 2018; 219:1274-1284. [DOI: 10.1093/infdis/jiy653] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 11/08/2018] [Indexed: 02/01/2023] Open
Affiliation(s)
- Sebastiaan O Verboeket
- Amsterdam UMC, University of Amsterdam, Departments of Global Health and Internal Medicine, Amsterdam Infection and Immunity Institute and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Ferdinand W Wit
- Amsterdam UMC, University of Amsterdam, Departments of Global Health and Internal Medicine, Amsterdam Infection and Immunity Institute and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- HIV Monitoring Foundation, Amsterdam, The Netherlands
| | - Greg D Kirk
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - M Bradley Drummond
- Division of Pulmonary and Critical Care Medicine, University of North Carolina, Chapel Hill
| | | | - Rosan A van Zoest
- Amsterdam UMC, University of Amsterdam, Departments of Global Health and Internal Medicine, Amsterdam Infection and Immunity Institute and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Jeannine F Nellen
- Amsterdam UMC, University of Amsterdam, Departments of Global Health and Internal Medicine, Amsterdam Infection and Immunity Institute and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Maarten F Schim van der Loeff
- Amsterdam UMC, University of Amsterdam, Departments of Global Health and Internal Medicine, Amsterdam Infection and Immunity Institute and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Infectious Diseases, Public Health Service of Amsterdam, The Netherlands
| | - Peter Reiss
- Amsterdam UMC, University of Amsterdam, Departments of Global Health and Internal Medicine, Amsterdam Infection and Immunity Institute and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- HIV Monitoring Foundation, Amsterdam, The Netherlands
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Boender TS, Smit C, Sighem AV, Bezemer D, Ester CJ, Zaheri S, Wit FWNM, Reiss P. AIDS Therapy Evaluation in the Netherlands (ATHENA) national observational HIV cohort: cohort profile. BMJ Open 2018; 8:e022516. [PMID: 30249631 PMCID: PMC6169757 DOI: 10.1136/bmjopen-2018-022516] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE In 1998, the AIDS Therapy Evaluation in the Netherlands (ATHENA) national observational HIV cohort was established to demonstrate the lifesaving effectiveness of triple combination antiretroviral therapy, including HIV-protease inhibitors, that had recently been made available for clinical use. Subsequently, the HIV Monitoring Foundation was established by the Dutch Ministry of Health, Welfare and Sport to continue ATHENA as an open cohort in order to continue the registration and monitoring of all HIV-positive people as an integral part of HIV care in all 26 HIV treatment centres in the Netherlands. PARTICIPANTS To date, a total of 25 036 participants have been enrolled in the cohort, with 263 600 person-years of follow-up. As of 1 January 2017, 19 035 HIV-1-positive participants were known to be in care: 18 824 adults (81% men and 19% women) and 211 children (47% boys and 53% girls). The remaining 6001 participants had either died (46%), were lost to care (29%) or had moved abroad (25%). FINDINGS TO DATE Today, with over 20 years of follow-up, the ATHENA cohort has provided extensive knowledge on HIV treatment, comorbidities and coinfections and created insight into the transmission dynamics of the HIV epidemic. FUTURE PLANS ATHENA continues to enrol and monitor HIV positive people entering HIV care in the Netherlands. Future research will continue to provide tangible input into HIV care and prevention policies in the Netherlands and internationally.
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Affiliation(s)
| | - Colette Smit
- Stichting HIV Monitoring, Amsterdam, the Netherlands
| | | | | | | | - Sima Zaheri
- Stichting HIV Monitoring, Amsterdam, the Netherlands
| | - Ferdinand W N M Wit
- Stichting HIV Monitoring, Amsterdam, the Netherlands
- Department of Global Health, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands
- Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
| | - Peter Reiss
- Stichting HIV Monitoring, Amsterdam, the Netherlands
- Department of Global Health, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands
- Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
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Phanuphak N, Pattanachaiwit S, Pankam T, Teeratakulpisarn N, Chamnan P, Pathipvanich P, Thongpaen S, Nonenoy S, Jantarapakde J, Pengnonyang S, Trachunthong D, Sungsing T, Parasate K, Seeneewong Na Ayutthaya S, Trairat K, Pussadee K, Lertpiriyasuwat C, Phanuphak P, the Thai MSM/TG Test and Treat Study Group. Sexually transmitted infections and HIV RNA levels in blood and anogenital compartments among Thai men who have sex with men before and after antiretroviral therapy: implication for Treatment as Prevention programme. J Int AIDS Soc 2018; 21:e25186. [PMID: 30225927 PMCID: PMC6141901 DOI: 10.1002/jia2.25186] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 08/13/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Sexually transmitted infections (STIs) are common among HIV-positive men who have sex with men (MSM). There have been concerns that undiagnosed and untreated STIs could undermine efforts to use antiretroviral therapy (ART) for prevention due to genital secretion infectiousness. We evaluated the correlation between STIs and HIV RNA in anogenital compartments among HIV-positive MSM before and after ART. METHODS MSM participants newly diagnosed with HIV were offered ART regardless of CD4 count during November 2012 to November 2015. Syphilis serology, oropharyngeal swab, rectal swab, urine collection for gonorrhoea and chlamydia nucleic acid amplification testing, and HIV RNA measurement in blood, semen and rectal samples were performed at baseline, 12 and 24 months thereafter. RESULTS Of 143 HIV-positive MSM, 16.1% had syphilis, 23.1% had gonorrhoea and 32.8% had chlamydia at baseline. Participants with STIs at baseline had higher median HIV RNA levels in blood plasma (p = 0.053), seminal plasma (p = 0.01) and rectal secretions (p = 0.002) than those without STIs. Multivariate models identified HIV RNA 100,000 to 500,000 (OR 6.74, 95% CI 2.24 to 20.28, p = 0.001) and >500,000 (OR 9.39, 95% CI 1.08 to 81.72, p = 0.04) copies/mL in blood, CD4 count <350 cells/mm3 (OR 4.20, 95% CI 1.05 to 16.70, p = 0.04) and having any STIs (OR 2.62, 95% CI 1.01 to 6.80 p = 0.047) to be associated with detectable (>40 copies/mL) seminal plasma HIV RNA. Having chlamydia at any sites (OR 3.17, 95% CI 1.07 to 9.44, p = 0.04) was associated with detectable rectal HIV RNA. Incidences of syphilis, gonorrhoea and chlamydia were 13.4, 16.4 and 18.1 per 100 person-years respectively. Nine participants had detectable HIV RNA (five in blood, one in semen, two in rectal samples and one in both blood and rectal samples) at 12 and/or 24 months after ART. CONCLUSIONS STIs were extremely common among HIV-positive MSM prior to and after ART. ART effectively reduced HIV RNA in all compartments. The correlation between STIs and anogenital HIV RNA, especially prior to ART and likely until complete HIV RNA suppression from ART is achieved, points to the importance of integrating asymptomatic STIs screening into Treatment as Prevention programme for MSM.
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Affiliation(s)
| | | | - Tippawan Pankam
- PREVENTIONThai Red Cross AIDS Research CentreBangkokThailand
| | | | - Parinya Chamnan
- Tawanghin Community Medical Care Center‐Sanpasitthiprasong HospitalUbonratchathaniThailand
| | | | | | | | | | | | | | | | - Kittiyaporn Parasate
- Tawanghin Community Medical Care Center‐Sanpasitthiprasong HospitalUbonratchathaniThailand
| | | | | | | | | | - Praphan Phanuphak
- PREVENTIONThai Red Cross AIDS Research CentreBangkokThailand
- HIV‐NATThai Red Cross AIDS Research CentreBangkokThailand
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Calendar trends in sexual behaviours in a cohort of HIV-infected MSM at the era of treatment as prevention of HIV infection. AIDS 2018; 32:1871-1879. [PMID: 29927787 DOI: 10.1097/qad.0000000000001916] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND With the advent of treatment as prevention of HIV infection (TasP), we assessed trends in sexual behaviours between 2000 and 2017 among HIV-infected MSM enrolled in the French ANRS PRIMO cohort. METHODS At each cohort visit, a clinical questionnaire including laboratory values was completed and a self-administered questionnaire was used to collect sexual behaviours, that is, the number, type (steady/casual) and HIV status (positive or negative/unknown) of partners, and condom use. The possible influence of viral load (undetectable/detectable) measured at the preceding visit on the evolution over time of sexual behaviour was assessed with logistic regression models fitted by generalized estimating equations (GEE), taking into account longitudinal data. RESULTS We analyzed data from 10657 follow-up visits by 1364 MSM. Overall, whatever the considered behavioural variable: at least one sexual partner, steady and/or casual, condomless sex with steady, casual partners, serodiscordant or not, we observed a calendar increase with a particularly more marked rise from 2010 (P < 0.0001). Inconsistent condom use did not differ according to the viral load status (detectable vs. undetectable). Trends in inconsistent condom use increased across different generations of MSM, as defined by the year they were diagnosed with HIV infection. CONCLUSIONS 'Having a sexual partner' and condomless sex, both increased in frequency between 2000 and 2017. Viral load status did not influence condom use as could have been expected from the 2008 Swiss Statement.
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Abstract
OBJECTIVE Sexual risk behaviour changes during a person's life course. Insights in sexual risk behaviour trajectories of MSM may provide starting points for the timing of HIV prevention methods. We aimed to study longitudinal trajectories of sexual risk behaviour predictive of HIV acquisition from sexual debut onwards. DESIGN A longitudinal study among 815 HIV-negative participants of the Amsterdam Cohort Studies (ACS) who completed extensive questionnaires about their sexual behaviour every 6 months between 2007 and 2017. METHODS A comprehensive behavioural risk score predictive of HIV seroconversion was developed. On the basis of this risk score, linear trajectories of sexual risk behaviour and MSM group membership were estimated using latent class growth mixture modelling. Associations between longitudinal trajectories and demographic and psychosocial factors were examined. RESULTS Three trajectories of sexual risk behaviour were identified, which were labelled Low risk (90.3% of the sample), Falling high risk (6.5%) and Rising high risk (3.3%). MSM following the Falling high risk (20.5%) and Rising high risk (25.0%) trajectories were more likely to acquire HIV during follow-up. The Falling high risk trajectory was associated with younger age at sexual debut, fewer steady partnerships and high percentages of substance use. The Rising high-risk trajectory was associated with increasing percentages of substance use over time. CONCLUSION MSM follow different trajectories of changing sexual risk behaviour over time. Early identification of MSM following a trajectory of falling or rising high-risk behaviour and adequate timing of individual-based preventive interventions may reduce HIV transmission.
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Yang Y, Zhao XP, Zou HC, Chu MJ, Zhong P, Li XS, Li XY, Yu YH, Zhu KX, Chen YJ, Xia F, Zhu BW, Ruan LQ, Bao YN, Zhuang X. Phylogenetic and temporal dynamics of human immunodeficiency virus type 1 CRF01_AE and CRF07_BC among recently infected antiretroviral therapy-naïve men who have sex with men in Jiangsu province, China, 2012 to 2015: A molecular epidemiology-based study. Medicine (Baltimore) 2018; 97:e9826. [PMID: 29419684 PMCID: PMC5944696 DOI: 10.1097/md.0000000000009826] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 12/31/2017] [Accepted: 01/17/2018] [Indexed: 11/25/2022] Open
Abstract
The prevalence and incidence of human immunodeficiency virus type 1 (HIV-1) among men who have sex with men (MSM) are on the rise throughout China. With a large population of MSM, Jiangsu Province is facing an escalating HIV-1 epidemic.The aim of this study was to explore the phylogenetic and temporal dynamics of HIV-1 CRF01_AE and CRF07_BC among antiretroviral therapy (ART)-naïve MSM recently infected with HIV-1 in Jiangsu Province.We recruited MSM in Jiangsu Province (Suzhou, Wuxi, Nantong, Taizhou and Yancheng) 2012 to 2015. We collected information on demographics and sexual behaviors and a blood sample for HIV genome RNA extraction, RT-PCR amplification, and DNA sequencing. Multiple alignments were made using Gene Cutter, with the selected reference sequences of various subtypes/recombinants from the Los Alamos HIV-1 database. Phylogenetic and Bayesian evolutionary analysis was performed by MEGA version 6.0, Fasttree v2.1.7. and BEAST v1.6.2. Categorical variables were analyzed using χ test (or Fisher exact test where necessary). χ test with trend was used to assess the evolution of HIV-1 subtype distribution over time. All data were analyzed using SPSS20.0 software package (IBM Company, New York, NY).HIV-1 phylogenetic analysis revealed a broad viral diversity including CRF01_AE (60.06%), CRF07_BC (22.29%), subtype B (5.88%), CRF67_01B (5.26%), CRF68_01B (2.79%), CRF55_01B (1.55%), CRF59_01B (0.93%), and CRF08_BC (0.62%). Two unique recombination forms (URFs) (0.62%) were also detected. Four epidemic clusters and 1 major cluster in CRF01_AE and CRF07_BC were identified. The introduction of CRF01_AE strain (2001) was earlier than CRF07_BC strain (2004) into MSM resided in Jiangsu based on the time of the most recent common ancestor.Our study demonstrated HIV-1 subtype diversity among ART-naïve MSM recently infected with HIV-1 in Jiangsu. We first depicted the spatiotemporal dynamics, traced the dates of origin for the HIV-1 CRF01_AE/07_BC strains and made inference for the effective population size among newly infected ART-naïve MSM in Jiangsu from 2012 to 2015. A real-time surveillance of HIV-1 viral diversity and phylodynamics of epidemic cluster would be of great value to the monitoring of the epidemic and control of transmission, improvement of antiretroviral therapy strategies, and design of vaccines.
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Affiliation(s)
- Yue Yang
- Department of Epidemiology and Health Statistics, School of
Public Health, Nantong University, Nantong
- Department of Infection Management Office, the First
Affiliated Hospital with Nanjing Medical University, Jiangsu Province Hospital, Nanjing,
Jiangsu Province
- Department of AIDS and STD, Shanghai Municipal Center for
Disease Control and Prevention; Shanghai Municipal Institute for Preventive Medicine,
Shanghai
| | - Xiu-Ping Zhao
- Department of AIDS and STD, Suzhou Center for Disease
Prevention and Control, Suzhou, Jiangsu Province
| | - Hua-Chun Zou
- School of Public Health, Sun Yat-sen University, Guangzhou,
Guangdong Province, China
- Kirby Institute, University of New South Wales, Sydney,
Australia
| | - Min-Jie Chu
- Department of Epidemiology and Health Statistics, School of
Public Health, Nantong University, Nantong
| | - Ping Zhong
- Department of AIDS and STD, Shanghai Municipal Center for
Disease Control and Prevention; Shanghai Municipal Institute for Preventive Medicine,
Shanghai
| | - Xiao-Shan Li
- Teaching and Research Office of Epidemiology and Health
Statistics, School of Public Health, Southeast University, Nanjing, Jiangsu
Province
| | - Xiao-Yan Li
- Ningbo Medical Center Lihuili Eastern Hospital; Taipei
Medical University Ningbo Medical Center, Ningbo, Zhejiang Province, China
| | - Yu-Hui Yu
- Department of Epidemiology and Health Statistics, School of
Public Health, Nantong University, Nantong
| | - Ke-Xin Zhu
- Department of Epidemiology and Health Statistics, School of
Public Health, Nantong University, Nantong
| | - Yu-Jia Chen
- Department of Epidemiology and Health Statistics, School of
Public Health, Nantong University, Nantong
| | - Fei Xia
- Department of Epidemiology and Health Statistics, School of
Public Health, Nantong University, Nantong
| | - Bo-Wen Zhu
- Department of Epidemiology and Health Statistics, School of
Public Health, Nantong University, Nantong
| | - Luan-Qi Ruan
- Department of Epidemiology and Health Statistics, School of
Public Health, Nantong University, Nantong
| | - Yi-Ning Bao
- Department of Epidemiology and Health Statistics, School of
Public Health, Nantong University, Nantong
| | - Xun Zhuang
- Department of Epidemiology and Health Statistics, School of
Public Health, Nantong University, Nantong
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de Groen RA, Groothuismink ZMA, van Oord G, Kootstra NA, Janssen HLA, Prins M, Schinkel J, Boonstra A. NK cells in self-limited HCV infection exhibit a more extensively differentiated, but not memory-like, repertoire. J Viral Hepat 2017; 24:917-926. [PMID: 28414896 DOI: 10.1111/jvh.12716] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 04/03/2017] [Indexed: 01/30/2023]
Abstract
Natural killer (NK) cells have long been thought of as a purely innate immune cell population, but increasing reports have described developmental and functional qualities of NK cells that are commonly associated with cells of the adaptive immune system. Of these features, the ability of NK cells to acquire functional qualities associated with immunological memory and continuous differentiation resulting in the formation of specific NK cell repertoires has recently been highlighted in viral infection settings. By making use of a unique cohort of monitored, at-risk intravenous drug users in this study, we were able to dissect the phenotypic and functional parameters associated with NK cell differentiation and NK cell memory in patients 3 years after acute HCV infection and either the subsequent self-clearance or progression to chronicity. We observed increased expression of cytolytic mediators and markers CD56bright and NKp46+ of NK cells in patients with chronic, but not self-limited HCV infection. Patients with a self-limited infection expressed higher levels of differentiation-associated markers CD57 and KIRs, and lower levels of NKG2A. A more extensively differentiated NK cell phenotype is associated with self-clearance in HCV patients, while the NK cells of chronic patients exhibited more naïve and effector NK cell phenotypic and functional characteristics. The identification of these distinct NK cell repertoires may shed light on the role NK cells play in determining the outcome of acute HCV infections, and the underlying immunological defects that lead to chronicity.
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Affiliation(s)
- R A de Groen
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Z M A Groothuismink
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - G van Oord
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - N A Kootstra
- Department of Research, Cluster of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands.,Division of Infectious Diseases, Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - H L A Janssen
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Liver Clinic University Health Network, Division of Gastroenterology, University of Toronto, Toronto, ON, Canada
| | - M Prins
- Department of Research, Cluster of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands.,Division of Infectious Diseases, Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - J Schinkel
- Section of Clinical Virology, Department of Medical Microbiology, Academic Medical Center, Amsterdam, The Netherlands
| | - A Boonstra
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Hoornenborg E, Krakower DS, Prins M, Mayer KH. Pre-exposure prophylaxis for MSM and transgender persons in early adopting countries. AIDS 2017; 31:2179-2191. [PMID: 28991023 PMCID: PMC5812254 DOI: 10.1097/qad.0000000000001627] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
: Pre-exposure prophylaxis (PrEP) is a potent and underutilized HIV prevention tool. In this paper we review the state of knowledge regarding PrEP implementation for men who have sex with men and transgender persons in early adopting countries. We focus on implementation of PrEP in demonstration projects and clinical care, and describe the status of PrEP availability and uptake. We report on approaches to identifying appropriate PrEP candidates in real-world settings and on best practices for clinical monitoring. This includes the exclusion of undiagnosed HIV infection prior to PrEP initiation and longitudinal measurement of renal function, in light of safety data. Since adherence is the primary factor moderating the effectiveness of PrEP, we discuss effective adherence support interventions. Additionally, we review the evidence for risk compensation with PrEP use and opportunities to provide PrEP as part of comprehensive and inclusive preventive health programs. We summarize cost-effectiveness studies, including their variable conclusions because of differing underlying assumptions, and discuss the importance of budgetary impact for public health programs and health care insurers. Further, we emphasize a need for greater engagement of health care providers in PrEP to increase access. We conclude with recommendations for ways to improve future efforts at implementing PrEP.
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Affiliation(s)
- Elske Hoornenborg
- aPublic Health Service of Amsterdam, Department of Infectious Diseases bAcademic Medical Center, Department of Infectious Diseases, Center for Immunity and Infection Amsterdam (CINIMA), University of Amsterdam, the Netherlands cBeth Israel Deaconess Medical Center, Department of Medicine, Division of Infectious Diseases, Harvard Medical School dThe Fenway Institute, Fenway Health, Boston, Massachusetts, USA
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Marra E, King A, van Logchem E, van der Weele P, Mooij SH, Heijman T, Meijer CJLM, Verhagen DWM, van der Sande MAB, Schim van der Loeff MF. Anal HPV 16 and 18 viral load: A comparison between HIV-negative and -positive MSM and association with persistence. J Med Virol 2017; 90:76-83. [PMID: 28700080 DOI: 10.1002/jmv.24898] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 07/07/2017] [Indexed: 11/12/2022]
Abstract
Does anal HPV viral load explain the difference in anal HPV persistence between HIV-negative and -positive men who have sex with men (MSM)? MSM ≥18 years were recruited in Amsterdam, the Netherlands, in 2010-2011. Anal self-swabs were collected every 6 months and genotyped (SPF10 -PCR-DEIA-LIPA25 -system). HPV16 and HPV18 load was determined with a type specific quantitative (q)PCR, and compared between HIV-negative and -positive men using ranksum test. Persistence was defined as ≥3 positive samples for the same HPV-type. Determinants of persistent HPV16/18 infection and its association with HPV16/18 load were assessed with logistic regression. Of 777 recruited MSM, 54 and 22 HIV negative men were HPV16 and HPV18 positive at baseline, and 64 and 39 HIV-positive MSM. The geometric mean titer (GMT) of HPV16 was 19.6 (95%CI 10.1-38.0) and of HPV18 8.6 (95%CI 2.7-27.5) DNA copies/human cell. HPV16 and HPV18 load did not differ significantly between HIV-negative and -positive MSM (P = 0.7; P = 0.8, respectively). In multivariable analyses HPV16 load was an independent determinant of HPV16 persistence (OR 1.8, 95%CI 1.3-2.4). No difference in anal HPV viral load was found between HIV-positive and HIV-negative MSM. HPV 16/18 viral load is an independent determinant of type-specific persistence.
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Affiliation(s)
- Elske Marra
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Audrey King
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Elske van Logchem
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Pascal van der Weele
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.,Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - Sofie H Mooij
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands.,Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Titia Heijman
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Chris J L M Meijer
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - Dominique W M Verhagen
- Department of Internal Medicine, Jan van Goyen Medical Center, Amsterdam, the Netherlands
| | - Marianne A B van der Sande
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.,Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Maarten F Schim van der Loeff
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands.,Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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35
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Hess KL, Crepaz N, Rose C, Purcell D, Paz-Bailey G. Trends in Sexual Behavior Among Men Who have Sex with Men (MSM) in High-Income Countries, 1990-2013: A Systematic Review. AIDS Behav 2017; 21:2811-2834. [PMID: 28555317 PMCID: PMC5708163 DOI: 10.1007/s10461-017-1799-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
HIV diagnoses among men who have sex with men (MSM) have been increasing in several high-income countries. A better understanding of the sexual behavior trends among MSM can be useful for informing HIV prevention. We conducted a systematic review of studies that examined behavioral trends (1990-2013) in any condomless anal sex, condomless anal sex with an HIV-discordant partner, and number of partners. Studies included come from the United States, Europe, and Australia. We found increasing trends in condomless anal sex and condomless anal sex with an HIV-discordant partner, and a decreasing trend in number of partners. The increase in condomless anal sex may help to explain the increase in HIV infections. More explanatory research is needed to provide insight into factors that contribute to these behavior trends. Continuous monitoring of HIV, risk behaviors, and use of prevention and treatment is needed to evaluate prevention efforts and monitor HIV transmission risk.
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Affiliation(s)
- Kristen L Hess
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-47, Atlanta, GA, 30329, USA.
| | - Nicole Crepaz
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-47, Atlanta, GA, 30329, USA
| | - Charles Rose
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-47, Atlanta, GA, 30329, USA
| | - David Purcell
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-47, Atlanta, GA, 30329, USA
| | - Gabriela Paz-Bailey
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-47, Atlanta, GA, 30329, USA
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Limited overlap between phylogenetic HIV and hepatitis C virus clusters illustrates the dynamic sexual network structure of Dutch HIV-infected MSM. AIDS 2017; 31:2147-2158. [PMID: 28692530 DOI: 10.1097/qad.0000000000001592] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE MSM are at increased risk for infection with HIV-1 and hepatitis C virus (HCV). Is HIV/HCV coinfection confined to specific HIV transmission networks? DESIGN AND METHODS A HIV phylogenetic tree was constructed for 5038 HIV-1 subtype B polymerase (pol) sequences obtained from MSM in the AIDS therapy evaluation in the Netherlands cohort. We investigated the existence of HIV clusters with increased HCV prevalence, the HIV phylogenetic density (i.e. the number of potential HIV transmission partners) of HIV/HCV-coinfected MSM compared with HIV-infected MSM without HCV, and the overlap in HIV and HCV phylogenies using HCV nonstructural protein 5B sequences from 183 HIV-infected MSM with acute HCV infection. RESULTS Five hundred and sixty-three of 5038 (11.2%) HIV-infected MSM tested HCV positive. Phylogenetic analysis revealed 93 large HIV clusters (≥10 MSM), 370 small HIV clusters (2-9 MSM), and 867 singletons with a median HCV prevalence of 11.5, 11.6, and 9.3%, respectively. We identified six large HIV clusters with elevated HCV prevalence (range 23.5-46.2%). Median HIV phylogenetic densities for MSM with HCV (3, interquartile range 1-7) and without HCV (3, interquartile range 1-8) were similar. HCV phylogeny showed 12 MSM-specific HCV clusters (clustersize: 2-39 HCV sequences); 12.7% of HCV infections were part of the same HIV and HCV cluster. CONCLUSION We observed few HIV clusters with elevated HCV prevalence, no increase in the HIV phylogenetic density of HIV/HCV-coinfected MSM compared to HIV-infected MSM without HCV, and limited overlap between HIV and HCV phylogenies among HIV/HCV-coinfected MSM. Our data do not support the existence of MSM-specific sexual networks that fuel both the HIV and HCV epidemic.
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van Santen DK, van der Helm JJ, Del Amo J, Meyer L, D'Arminio Monforte A, Price M, Béguelin CA, Zangerle R, Sannes M, Porter K, Geskus RB, Prins M. Lack of decline in hepatitis C virus incidence among HIV-positive men who have sex with men during 1990-2014. J Hepatol 2017; 67:255-262. [PMID: 28412290 DOI: 10.1016/j.jhep.2017.03.038] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 01/30/2017] [Accepted: 03/30/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND & AIMS Hepatitis C virus (HCV) incidence among HIV-positive men who have sex with men (MSM) has increased since 2000, although there are regional differences. We aimed to 1) estimate trends in HCV incidence among HIV-positive MSM, 2) assess the association between incidence and geographical region, age and HIV-related measurements and, 3) assess temporal changes from HIV seroconversion to HCV infection. METHODS Data was used from MSM with well-estimated dates of HIV seroconversion from the CASCADE Collaboration (1990-2014). Smoothly varying trends in HCV incidence over time were allowed, using restricted cubic splines. The association of calendar year, age, CD4 count (lagged), HIV RNA (lagged), geographical region and HIV infection stage (recent vs. chronic) with HCV incidence were assessed using Poisson regression. RESULTS Of 5,941 MSM, 337 acquired HCV during follow-up. HCV incidence significantly increased from 0.7/1,000 person-years in 1990 to 18/1,000 person-years in 2014. Recent calendar years, younger age, recent HIV infection and higher HIV RNA levels were significantly associated with HCV incidence, while CD4 count was not. Trends differed by geographical region; while incidence appeared to have stabilized in Western Europe and remained stable in Southern Europe, it continued to increase in Northern Europe in recent years. Time from HIV to HCV infection significantly decreased over time (p<0.001). CONCLUSIONS HCV has continued to spread among HIV-positive MSM in recent years, but trends differ by geographical region. Interventions to decrease the risk of HCV acquisition and increase early diagnosis are warranted. LAY SUMMARY Hepatitis C virus infection continues to spread among HIV-positive men who have sex with men, especially among younger individuals. However, trends seem to differ by European region in recent years. Furthermore, men who have sex with men with a higher HIV RNA load were more likely to get infected with the hepatitis C virus. During recent HIV infection, MSM appear to be at higher risk of acquiring hepatitis C.
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Affiliation(s)
- Daniela Katinka van Santen
- Department of Infectious Disease Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands.
| | - Jannie Johanna van der Helm
- Department of Infectious Disease Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Julia Del Amo
- National Centre of Epidemiology, Instituto de Salud Carlos III (Madrid) and CIBERESP, Spain
| | - Laurence Meyer
- INSERM CESP U1018, Centre de recherche en Epidemiologie et Sante des Populations, Universite Paris Sud, Le Kremlin Bicetre, France
| | - Antonella D'Arminio Monforte
- Department of Health Sciences, Clinic of Infectious and Tropical Diseases, S Paolo Hospital, University of Milan, Milan, Italy
| | - Matt Price
- International AIDS Vaccine Initiative, New York City, NY, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | | | - Robert Zangerle
- Department of Dermatology and Venereology, Medical University of Innsbruck, Innsbruck, Austria
| | - Mette Sannes
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Kholoud Porter
- Research Department of Infection and Population Health, University College London, London, United Kingdom
| | - Ronald Bertus Geskus
- Department of Infectious Disease Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Maria Prins
- Department of Infectious Disease Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands; Department of Infectious Diseases, Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center (AMC), Amsterdam, the Netherlands
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Dijkstra M, de Bree GJ, Stolte IG, Davidovich U, Sanders EJ, Prins M, Schim van der Loeff MF. Development and validation of a risk score to assist screening for acute HIV-1 infection among men who have sex with men. BMC Infect Dis 2017; 17:425. [PMID: 28615005 PMCID: PMC5471739 DOI: 10.1186/s12879-017-2508-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 05/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early treatment of acute HIV-1 infection (AHI) is beneficial for patients and could reduce onward transmission. However, guidelines on whom to test for AHI with HIV-1 RNA testing are lacking. METHODS A risk score for possible AHI based on literature and expert opinion - including symptoms associated with AHI and early HIV-1 - was evaluated using data from the Amsterdam Cohort Studies among men who have sex with men (MSM). Subsequently, we optimized the risk score by constructing two multivariable logistic regression models: one including only symptoms and one combining symptoms with known risk factors for HIV-1 seroconversion, using generalized estimating equations. Several risk scores were generated from these models and the optimal risk score was validated using data from the Multicenter AIDS Cohort Study. RESULTS Using data from 1562 MSM with 175 HIV-1 seroconversion visits and 17,271 seronegative visits in the Amsterdam Cohort Studies, the optimal risk score included four symptoms (oral thrush, fever, lymphadenopathy, weight loss) and three risk factors (self-reported gonorrhea, receptive condomless anal intercourse, more than five sexual partners, all in the preceding six months) and yielded an AUC of 0.82. Sensitivity was 76.3% and specificity 76.3%. Validation in the Multicenter AIDS Cohort Study resulted in an AUC of 0.78, sensitivity of 56.2% and specificity of 88.8%. CONCLUSIONS The optimal risk score had good overall performance in the Amsterdam Cohort Studies and performed comparable (but showed lower sensitivity) in the validation study. Screening for AHI with four symptoms and three risk factors would increase the efficiency of AHI testing and potentially enhance early diagnosis and immediate treatment.
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Affiliation(s)
- Maartje Dijkstra
- Academic Medical Center, Department of Infectious Diseases, University of Amsterdam, P.O. Box 22700, 1100DE, Amsterdam, the Netherlands.,Public Health Service of Amsterdam, Department of Infectious Diseases, Research and Prevention, P.O. Box 2200, 1000CE, Amsterdam, the Netherlands
| | - Godelieve J de Bree
- Academic Medical Center, Department of Infectious Diseases, University of Amsterdam, P.O. Box 22700, 1100DE, Amsterdam, the Netherlands. .,Amsterdam Institute for Global Health and Development, University of Amsterdam, P.O. Box 22700, 1100DE, Amsterdam, the Netherlands.
| | - Ineke G Stolte
- Public Health Service of Amsterdam, Department of Infectious Diseases, Research and Prevention, P.O. Box 2200, 1000CE, Amsterdam, the Netherlands
| | - Udi Davidovich
- Academic Medical Center, Department of Infectious Diseases, University of Amsterdam, P.O. Box 22700, 1100DE, Amsterdam, the Netherlands.,Public Health Service of Amsterdam, Department of Infectious Diseases, Research and Prevention, P.O. Box 2200, 1000CE, Amsterdam, the Netherlands
| | - Eduard J Sanders
- Amsterdam Institute for Global Health and Development, University of Amsterdam, P.O. Box 22700, 1100DE, Amsterdam, the Netherlands.,Kenya Medical Research Institute, Centre for Geographic Medicine Research -Coast, P.O. Box 230, Kilifi, Kenya.,Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7BN, UK
| | - Maria Prins
- Academic Medical Center, Department of Infectious Diseases, University of Amsterdam, P.O. Box 22700, 1100DE, Amsterdam, the Netherlands.,Public Health Service of Amsterdam, Department of Infectious Diseases, Research and Prevention, P.O. Box 2200, 1000CE, Amsterdam, the Netherlands
| | - Maarten F Schim van der Loeff
- Academic Medical Center, Department of Infectious Diseases, University of Amsterdam, P.O. Box 22700, 1100DE, Amsterdam, the Netherlands.,Public Health Service of Amsterdam, Department of Infectious Diseases, Research and Prevention, P.O. Box 2200, 1000CE, Amsterdam, the Netherlands
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Achterbergh RCA, van der Helm JJ, van den Brink W, de Vries HJC. Design of a syndemic based intervention to facilitate care for men who have sex with men with high risk behaviour: the syn.bas.in randomized controlled trial. BMC Infect Dis 2017; 17:398. [PMID: 28587607 PMCID: PMC5461721 DOI: 10.1186/s12879-017-2474-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 05/18/2017] [Indexed: 11/10/2022] Open
Abstract
Background Men who have sex with men (MSM) constitute a risk group for sexual transmitted infections (STIs), including HIV. Despite counselling interventions, risk behaviour remains high. Syndemic theory holds that psychosocial problems often co-occur, interact and mutually reinforce each other, thereby increasing high risk behaviours and co-occurring diseases. Therefore, if co-occurring psychosocial problems were assessed and treated simultaneously, this might decrease high risk behaviour and disease. Method An open label randomized controlled trial will be conducted among 150 MSM with high risk behaviour recruited from the STI clinic of Amsterdam. Inclusion criteria are: HIV negative MSM with two STI and/or PEP treatment in the last 24 months, or HIV positive MSM with one STI in the last 24 months. All participants get questionnaires on the following syndemic domains: ADHD, depression, anxiety disorder, alexithymia and sex- and drug addiction. Participants in the control group receive standard care: STI screenings every three months and motivational interviewing based counselling. Participants in the experimental group receive standard care plus feedback based on the results of the questionnaires. All participants can be referred to co-located mental health or addiction services. The primary outcome is help seeking behaviour for mental health problems and/or drug use problems. The secondary outcomes are STI incidence and changes in sexual risk behaviour (i.e. condom use, number of anal sex partners, drug use during sex). Discussion This study will provide information on syndemic domains among MSM who show high risk behaviour and on the effect of screening and referral on help seeking behaviour and health (behaviour) outcomes. Trial registration Trial Registration at clinicaltrail.gov, identifier NCT02859935.
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Affiliation(s)
- Roel C A Achterbergh
- STI outpatient clinic, Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
| | - Jannie J van der Helm
- STI outpatient clinic, Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Henry J C de Vries
- STI outpatient clinic, Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands. .,Department of Dermatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. .,Amsterdam Infection & Immunity Institute (AI&II), Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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Marzel A, Shilaih M, Turk T, Campbell NK, Yang WL, Böni J, Yerly S, Klimkait T, Aubert V, Furrer H, Calmy A, Battegay M, Cavassini M, Bernasconi E, Schmid P, Metzner KJ, Günthard HF, Kouyos RD. Mining for pairs: shared clinic visit dates identify steady HIV-positive partnerships. HIV Med 2017; 18:667-676. [PMID: 28378387 DOI: 10.1111/hiv.12507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Here we examined the hypothesis that some stable HIV-infected partnerships can be found in cohort studies, as the patients frequently attend the clinic visits together. METHODS Using mathematical approximations and shuffling to derive the probabilities of sharing a given number of visits by chance, we identified and validated couples that may represent either transmission pairs or serosorting couples in a stable relationship. RESULTS We analysed 434 432 visits for 16 139 Swiss HIV Cohort Study patients from 1990 to 2014. For 89 pairs, the number of shared visits exceeded the number expected. Of these, 33 transmission pairs were confirmed on the basis of three criteria: an extensive phylogenetic tree, a self-reported steady HIV-positive partnership, and risk group affiliation. Notably, 12 of the validated transmission pairs (36%; 12 of 33) were of a mixed ethnicity with a large median age gap [17.5 years; interquartile range (IQR) 11.8-22 years] and these patients harboured HIV-1 of predominantly non-B subtypes, suggesting imported infections. CONCLUSIONS In the context of the surge in research interest in HIV transmission pairs, this simple method widens the horizons of research on within-pair quasi-species exchange, transmitted drug resistance and viral recombination at the biological level and targeted prevention at the public health level.
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Affiliation(s)
- A Marzel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, Swiss National Center for Retroviruses, University of Zurich, Zurich, Switzerland
| | - M Shilaih
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, Swiss National Center for Retroviruses, University of Zurich, Zurich, Switzerland
| | - T Turk
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, Swiss National Center for Retroviruses, University of Zurich, Zurich, Switzerland
| | - N K Campbell
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, Swiss National Center for Retroviruses, University of Zurich, Zurich, Switzerland
| | - W-L Yang
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - J Böni
- Institute of Medical Virology, Swiss National Center for Retroviruses, University of Zurich, Zurich, Switzerland
| | - S Yerly
- Laboratory of Virology, Geneva University Hospital, Geneva, Switzerland
| | - T Klimkait
- Molecular Virology, Department of Biomedicine-Petersplatz, University of Basel, Basel, Switzerland
| | - V Aubert
- Division of Immunology and Allergy, University Hospital Lausanne, Lausanne, Switzerland
| | - H Furrer
- Department of Infectious Diseases, Berne University Hospital and University of Berne, Berne, Switzerland
| | - A Calmy
- Division of Infectious Diseases, Geneva University Hospital, Geneva, Switzerland
| | - M Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - M Cavassini
- Service of Infectious Diseases, Lausanne University Hospital, Lausanne, Switzerland
| | - E Bernasconi
- Division of Infectious Diseases, Regional Hospital Lugano, Lugano, Switzerland
| | - P Schmid
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital, St. Gallen, Switzerland
| | - K J Metzner
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, Swiss National Center for Retroviruses, University of Zurich, Zurich, Switzerland
| | - H F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, Swiss National Center for Retroviruses, University of Zurich, Zurich, Switzerland
| | - R D Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, Swiss National Center for Retroviruses, University of Zurich, Zurich, Switzerland
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Heijman T, Zuure F, Stolte I, Davidovich U. Motives and barriers to safer sex and regular STI testing among MSM soon after HIV diagnosis. BMC Infect Dis 2017; 17:194. [PMID: 28264658 PMCID: PMC5339973 DOI: 10.1186/s12879-017-2277-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 02/21/2017] [Indexed: 02/07/2023] Open
Abstract
Background Understanding why some recently with HIV diagnosed men who have sex with men (MSM) choose for safer sex and regular STI testing, whereas others do not, is important for the development of interventions that aim to improve the sexual health of those newly infected. Methods To gain insight into motives and barriers to condom use and regular STI testing among MSM soon after HIV diagnosis, 30 HIV-positive MSM participated in semi-structured qualitative interviews on sexual health behaviours in the first year after HIV diagnosis. Results Typical barriers to condom use soon after diagnosis were emotions such as anger, relief, and feelings of vulnerability. Additional barriers were related to pre-diagnosis patterns of sexual-social behaviour that were difficult to change, communication difficulties, and substance use. Barriers to STI testing revolved around perceptions of low STI risk, faulty beliefs, and burdensome testing procedures. Conclusions The great diversity of motives and barriers to condom use and STI testing creates a challenge to accommodate newly infected men with information, motivation, and communication skills to match their personal needs. An adaptive, tailored intervention can be a promising tool of support.
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Affiliation(s)
- Titia Heijman
- STI outpatient Clinic, Amsterdam Public Health Service, Amsterdam, The Netherlands.
| | - Freke Zuure
- Department Infectious Diseases, Research and Prevention, Amsterdam Public Health Service, Amsterdam, The Netherlands.,Centre for Infection and Immunology Amsterdam (CINIMA), Academic Medical Centre (University of Amsterdam), Amsterdam, The Netherlands
| | - Ineke Stolte
- University of applied sciences InHolland, Haarlem, The Netherlands
| | - Udi Davidovich
- Department Infectious Diseases, Research and Prevention, Amsterdam Public Health Service, Amsterdam, The Netherlands.,Centre for Infection and Immunology Amsterdam (CINIMA), Academic Medical Centre (University of Amsterdam), Amsterdam, The Netherlands
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Desai S, Nardone A, Hughes G, Delpech V, Burns F, Hart G, Gill ON. HIV incidence in an open national cohort of men who have sex with men attending sexually transmitted infection clinics in England. HIV Med 2017; 18:615-622. [PMID: 28127837 DOI: 10.1111/hiv.12498] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of the study was to determine HIV incidence among men who have sex with men (MSM) who repeat test for HIV at sexually transmitted infection (STI) clinics in England, and identify associated factors. METHODS Annual HIV incidence and 95% confidence interval (CI) were calculated for a national cohort of MSM who tested HIV negative at any STI clinic in England in 2012 and had a follow-up test within 1 year using routinely collected data. Cox regression analyses were performed to identify predictors of HIV acquisition and population attributable risk for HIV infection was calculated for predictors. RESULTS In 2012, 85 500 MSM not known to be HIV positive attended any STI clinic in England, and 31% tested for HIV at least twice within 1 year at the same clinic. HIV incidence was 2.0 per 100 person-years (PY; 95% CI 1.8-2.2) among repeat testers. Incidence was higher among MSM of black ethnicity (3.2 per 100 PY) and those with a bacterial STI diagnosis at the initial attendance (3.2 per 100 PY). MSM with a previous syphilis or gonorrhoea infection were at significantly greater risk of acquiring HIV in the subsequent year [adjusted hazard ratio 4.1 (95% CI 2.0-8.3) and 2.1 (95% CI 1.4-3.2), respectively]. The predictors accounted for 37% of HIV infections. CONCLUSIONS Annual HIV incidence among MSM attending STI clinics in England is high. Previous STIs were predictors of HIV acquisition but only accounted for one in five infections. More discriminatory behavioural predictors of HIV acquisition could provide better triaging of HIV prevention services for MSM attending STI clinics.
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Affiliation(s)
- S Desai
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.,Research Department of Infection & Population Health, University College London, London, UK
| | - A Nardone
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - G Hughes
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - V Delpech
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - F Burns
- Research Department of Infection & Population Health, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - G Hart
- Research Department of Infection & Population Health, University College London, London, UK
| | - O N Gill
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
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Is Group Sex a Higher-Risk Setting for HIV and Other Sexually Transmitted Infections Compared With Dyadic Sex Among Men Who Have Sex With Men? Sex Transm Dis 2016; 43:99-104. [PMID: 26766526 DOI: 10.1097/olq.0000000000000389] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Group sex has been suggested as a potential high-risk setting for HIV and other sexually transmitted infections (STIs) among men who have sex with men (MSM). We investigated whether group sex is associated with lower condom use during anal sex and higher proportions of STIs compared with dyadic sex among HIV-negative MSM between 2009 and 2012. METHODS Cross-sectional data from 7 data waves of the Amsterdam Cohort Studies were used. The sample consisted of 465 MSM who either reported both group and dyadic sex (at n = 706 visits) or dyadic sex only (at n = 1339 visits) in the preceding 6 months. Logistic regression with generalized estimating equations was used to investigate the association between sexual setting (group vs. dyadic sex), condomless anal sex, and STI. RESULTS Group sex was reported at 35% (706/2045) of visits. Condomless sex was more often reported during dyadic than group sex (odds ratio, 3.64 95% confidence interval, 2.57-5.16). Men who had group sex were more likely diagnosed as having gonorrhea compared with men with dyadic sex (odds ratio, 1.71; 95% confidence interval, 1.08-2.97), but this effect was not retained in the multivariate model. CONCLUSIONS Results demonstrate within-person differences in sexual behavior during group and dyadic sex among MSM. Men were more likely to use condoms during group sex than during dyadic sex. Thus, for some, group sex may not necessarily be risky for HIV infection compared with dyadic sex. However, group sex may be a higher-risk setting for acquiring STIs other than HIV, such as gonorrhea. Group sex encounters should be recognized as distinct sexual settings with specific risk characteristics that need to be addressed accordingly.
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Wang N, Wu G, Lu R, Feng L, Xiao Y, McFarland W, Ruan Y, Shao Y, Raymond HF. Investigating HIV Infection and HIV Incidence Among Chinese Men Who Have Sex with Men with Recent Sexual Debut, Chongqing, China, 2011. AIDS Behav 2016; 20:2976-2982. [PMID: 26979418 DOI: 10.1007/s10461-016-1356-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
HIV among men who have sex with men (MSM) with recent male-male sexual debut, such as within the past 5 years, may be a proxy for recent HIV infection. Using this definition, we explored factors associated with HIV infection in this group to understand the evolving HIV epidemic among MSM in Chongqing. We conducted a cross-sectional respondent-driven sampling survey among Chongqing MSM in 2011. Computer-assisted, self-administered questionnaires were used and blood specimens were collected for HIV and syphilis testing. Three hundred and ninety-one unique MSM were recruited of which 65.7 % (257) had their sexual debut with another man in the past 5 years. HIV prevalence among men with recent sexual debut was 18.7 % suggesting a possible HIV incidence of 3.7 %. Multivariable analysis among men with recent sexual debut suggests that lower education, having more than one male partner, and currently being infected with syphilis are associated with HIV among men with recent sexual debut. HIV prevalence is high among MSM with recent sexual debut in Chongqing, which may be a proxy a high incidence rate. HIV prevention efforts should focus on STD reduction among those MSM with lower educational attainment.
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Affiliation(s)
- Na Wang
- Department of Public Health, Baotou Medical College, Baotou, China
- School of Public Health, Guangxi Medical University, Nanning, China
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Guohui Wu
- Chongqing Center for Disease Control and Prevention, Chongqing, People's Republic of China
| | - Rongrong Lu
- Chongqing Center for Disease Control and Prevention, Chongqing, People's Republic of China
| | - Liangui Feng
- Chongqing Center for Disease Control and Prevention, Chongqing, People's Republic of China
| | - Yan Xiao
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Willi McFarland
- San Francisco Department of Public Health, 25 Van Ness, Suite 500, San Francisco, CA, 94102, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, 94105, USA
| | - Yuhua Ruan
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Yiming Shao
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - H F Raymond
- San Francisco Department of Public Health, 25 Van Ness, Suite 500, San Francisco, CA, 94102, USA.
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, 94105, USA.
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Response to diversification of risk-reduction strategies and reduced threat of HIV may explain increases in condomless sex. AIDS 2016; 30:2900-2901. [PMID: 27824631 DOI: 10.1097/qad.0000000000001261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Reyniers T, Hoornenborg E, Vuylsteke B, Wouters K, Laga M. Pre-exposure prophylaxis (PrEP) for men who have sex with men in Europe: review of evidence for a much needed prevention tool. Sex Transm Infect 2016; 93:363-367. [PMID: 27872326 DOI: 10.1136/sextrans-2016-052699] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 10/09/2016] [Accepted: 10/29/2016] [Indexed: 11/04/2022] Open
Abstract
In many Western countries with good coverage of antiretroviral treatment (ART) programmes the annual number of HIV infections is still high and not (yet) declining among men who have sex with men (MSM). This might indicate that antiretroviral treatment roll-out alone will not turn around the course of the epidemic and that new, additional tools are needed. Antiretrovirals used as prevention tools for people not yet infected with HIV, such as pre-exposure prophylaxis (PrEP) could be such important additional tools. PrEP is a new type of biomedical prevention, which involves the use of antiretrovirals before, during and after (periods of) sexual exposure to HIV. In this review, we will focus on PrEP as a new prevention tool for MSM at high risk in Europe, including its evidence for effectiveness, challenges for implementation, ongoing European demonstration studies; as well as how PrEP relates to other existing prevention tools. In light of European Medicines Agency's recent recommendation for approval of PrEP we briefly review the potential implications.
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Affiliation(s)
- Thijs Reyniers
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Elske Hoornenborg
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, Netherlands
| | - Bea Vuylsteke
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kristien Wouters
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Marie Laga
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Bil JP, van der Veldt WM, Prins M, Stolte IG, Davidovich U. Motives of Dutch men who have sex with men for daily and intermittent HIV pre-exposure prophylaxis usage and preferences for implementation: A qualitative study. Medicine (Baltimore) 2016; 95:e4910. [PMID: 27684827 PMCID: PMC5265920 DOI: 10.1097/md.0000000000004910] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Although PrEP is not yet registered in Europe, including the Netherlands, its approval and implementation are expected in the near future. To inform future pre-exposure prophylaxis (PrEP) implementation, this study aimed to gain insight into motives and preferences for daily or intermittent PrEP use among Dutch HIV-negative men having sex with men (MSM).Between February and December 2013, semistructured interviews were conducted until data saturation was reached (N = 20). Interviews were analyzed using the Grounded Theory approach.Motives for (not) using daily PrEP were based on beliefs about PrEP efficacy and side effects, preferences for other prevention strategies, self-perceived HIV risk, self-perceived efficacy of PrEP adherence, beliefs about possible benefits (e.g., anxiety reduction, sex life improvement), and barriers of PrEP use (e.g., costs, monitoring procedures). The perceived benefits of intermittent versus daily PrEP use were the lower costs and side effects and the lower threshold to decision to start using intermittent PrEP. Barriers of intermittent PrEP versus daily PrEP use were the perceived need to plan their sex life and adhere to multiple prevention strategies. Although some perceived PrEP as a condom substitute, others were likely to combine PrEP and condoms for sexually transmitted infections (STI) prevention and increased HIV protection. Participants preferred PrEP service locations to have specialized knowledge of HIV, antiretroviral therapy, sexual behavior, STIs, patients' medical background, be easily approachable, be able to perform PrEP follow-up monitoring, and provide support.To maximize the public health impact of PrEP, ensuring high uptake among MSM at highest risk is important. Therefore, targeted information about PrEP efficacy and side effects need to be developed, barriers for accessing PrEP services should be minimized, and perceived self-efficacy to use PrEP should be addressed and improved. To prevent increases in STIs, condom use should be monitored and PrEP should be integrated into routine STI screening and counseling.
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Affiliation(s)
- Janneke P. Bil
- Department of Infectious Diseases Research and Prevention, Public Health Service Amsterdam, Amsterdam, the Netherlands
- Correspondence: Janneke P. Bil, MSc, Public Health Service Amsterdam, Department of Infectious Diseases Research and Prevention, P.O. Box 2200, 1000 CE Amsterdam, The Netherlands (e-mail: ); Udi Davidovich, Public Health Service Amsterdam, Department of Infectious Diseases Research and Prevention, P.O. Box 2200, 1000 CE Amsterdam, The Netherlands (e-mail: )
| | - Wendy M. van der Veldt
- Department of Infectious Diseases Research and Prevention, Public Health Service Amsterdam, Amsterdam, the Netherlands
| | - Maria Prins
- Department of Infectious Diseases Research and Prevention, Public Health Service Amsterdam, Amsterdam, the Netherlands
- Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center (AMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Ineke G. Stolte
- Department of Infectious Diseases Research and Prevention, Public Health Service Amsterdam, Amsterdam, the Netherlands
| | - Udi Davidovich
- Department of Infectious Diseases Research and Prevention, Public Health Service Amsterdam, Amsterdam, the Netherlands
- Correspondence: Janneke P. Bil, MSc, Public Health Service Amsterdam, Department of Infectious Diseases Research and Prevention, P.O. Box 2200, 1000 CE Amsterdam, The Netherlands (e-mail: ); Udi Davidovich, Public Health Service Amsterdam, Department of Infectious Diseases Research and Prevention, P.O. Box 2200, 1000 CE Amsterdam, The Netherlands (e-mail: )
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Rozhnova G, van der Loeff MFS, Heijne JCM, Kretzschmar ME. Impact of Heterogeneity in Sexual Behavior on Effectiveness in Reducing HIV Transmission with Test-and-Treat Strategy. PLoS Comput Biol 2016; 12:e1005012. [PMID: 27479074 PMCID: PMC4968843 DOI: 10.1371/journal.pcbi.1005012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 06/02/2016] [Indexed: 12/19/2022] Open
Abstract
The WHO’s early-release guideline for antiretroviral treatment (ART) of HIV infection based on a recent trial conducted in 34 countries recommends starting treatment immediately upon an HIV diagnosis. Therefore, the test-and-treat strategy may become more widely used in an effort to scale up HIV treatment and curb further transmission. Here we examine behavioural determinants of HIV transmission and how heterogeneity in sexual behaviour influences the outcomes of this strategy. Using a deterministic model, we perform a systematic investigation into the effects of various mixing patterns in a population of men who have sex with men (MSM), stratified by partner change rates, on the elimination threshold and endemic HIV prevalence. We find that both the level of overdispersion in the distribution of the number of sexual partners and mixing between population subgroups have a large influence on endemic prevalence before introduction of ART and on possible long term effectiveness of ART. Increasing heterogeneity in risk behavior may lead to lower endemic prevalence levels, but requires higher coverage levels of ART for elimination. Elimination is only feasible for populations with a rather low degree of assortativeness of mixing and requires treatment coverage of almost 80% if rates of testing and treatment uptake by all population subgroups are equal. In this case, for fully assortative mixing and 80% coverage endemic prevalence is reduced by 57%. In the presence of heterogeneity in ART uptake, elimination is easier to achieve when the subpopulation with highest risk behavior is tested and treated more often than the rest of the population, and vice versa when it is less. The developed framework can be used to extract information on behavioral heterogeneity from existing data which is otherwise hard to determine from population surveys. HIV is endemic in populations of MSM in Western countries. As ART reduces transmission risk, increased testing and treatment rates are expected to lower HIV incidence. However, concerns are that in MSM populations changing risk behavior may counteract the impact of ART on transmission. Using a mathematical model, we investigated how heterogeneity in sexual behavior influences the possible effects of a test-and-treat strategy on HIV prevalence and in particular the prospects of eliminating HIV from these populations. We demonstrated that behavioral heterogeneity plays an important role in determining the impact of ART on reducing HIV transmission. Knowledge of behavioral heterogeneity is key in setting intervention goals in populations of MSM.
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Affiliation(s)
- Ganna Rozhnova
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
- * E-mail:
| | - Maarten F. Schim van der Loeff
- Department of Infectious Disease Control, Public Health Service Amsterdam, Amsterdam, The Netherlands
- Center of Infection and Immunity Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - Janneke C. M. Heijne
- Centre for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Mirjam E. Kretzschmar
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
- Centre for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
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Association of HIV Infection With Anal and Penile Low-Risk Human Papillomavirus Infections Among Men Who Have Sex With Men in Amsterdam: The HIV & HPV in MSM Study. Sex Transm Dis 2016; 42:297-304. [PMID: 25970305 DOI: 10.1097/olq.0000000000000278] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study among men who have sex with men (MSM) aimed to (1) assess prevalence of anogenital low-risk human papillomavirus (lrHPV) infections, (2) evaluate associations with HIV infection, and (3) investigate lrHPV concordance. METHODS In 2010 to 2011, MSM 18 years or older were recruited in Amsterdam, the Netherlands, and provided anal and penile self-swabs (HIV & HPV in MSM study). Using the HPV SPF10-PCR/DEIA/LiPA25 system, the presence of lrHPV types 6, 11, 34, 40, 42, 43, 44, 53, 54, 66, 68/73, 70, and 74 could be detected. Logistic regression with generalized estimating equations was used to assess the independent effect of HIV on lrHPV infections. The model was repeated for lrHPV subcategories (nononcogenic and weakly oncogenic infections separately). Concordance was defined as detection of the same lrHPV type in both self-swabs of one individual. RESULTS A total of 778 MSM were included, of whom 317 (41%) were HIV positive (median CD4 count at enrollment, 530 cells/mm). Prevalence of anal lrHPV was 45% (95% confidence interval [CI], 41%-50%) in HIV-negative MSM and 69% (95% CI, 64%-74%) in HIV-positive MSM. Prevalence of penile lrHPV was 20% (95% CI, 16%-24%) and 37% (95% CI, 31%-42%), respectively. In multivariable analysis, HIV infection was independently associated with anal (adjusted odds ratio [aOR], 1.9; 95% CI, 1.5-2.3) and penile lrHPV (aOR, 2.0; 95% CI, 1.4-2.7). Nononcogenic and weakly oncogenic lrHPV subcategories showed a similar pattern of association. Anal lrHPV infections were strongly associated with the presence of a type-concordant penile infection (aOR, 5.8; 95% CI, 4.4-7.5) and vice versa (aOR, 5.7; 95% CI, 4.4-7.5). CONCLUSIONS Anal and penile infections with lrHPV are common in MSM. HIV infection was an independent determinant for lrHPV infections.
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50
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Abstract
BACKGROUND Estimates of the size of the undiagnosed HIV-infected population are important to understand the HIV epidemic and to plan interventions, including "test-and-treat" strategies. METHODS We developed a multi-state back-calculation model to estimate HIV incidence, time between infection and diagnosis, and the undiagnosed population by CD4 count strata, using surveillance data on new HIV and AIDS diagnoses. The HIV incidence curve was modelled using cubic splines. The model was tested on simulated data and applied to surveillance data on men who have sex with men in The Netherlands. RESULTS The number of HIV infections could be estimated accurately using simulated data, with most values within the 95% confidence intervals of model predictions. When applying the model to Dutch surveillance data, 15,400 (95% confidence interval [CI] = 15,000, 16,000) men who have sex with men were estimated to have been infected between 1980 and 2011. HIV incidence showed a bimodal distribution, with peaks around 1985 and 2005 and a decline in recent years. Mean time to diagnosis was 6.1 (95% CI = 5.8, 6.4) years between 1984 and 1995 and decreased to 2.6 (2.3, 3.0) years in 2011. By the end of 2011, 11,500 (11,000, 12,000) men who have sex with men in The Netherlands were estimated to be living with HIV, of whom 1,750 (1,450, 2,200) were still undiagnosed. Of the undiagnosed men who have sex with men, 29% (22, 37) were infected for less than 1 year, and 16% (13, 20) for more than 5 years. CONCLUSIONS This multi-state back-calculation model will be useful to estimate HIV incidence, time to diagnosis, and the undiagnosed HIV epidemic based on routine surveillance data.
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