High and persistent HIV seroincidence in men who have sex with men across 47 U.S. cities

• Published in: PloS one Vol. 7; no. 4; p. e34972
• Main Authors: Ackers, Marta-Louise, Greenberg, Alan E, Lin, Carol Y, Bartholow, Bradford N, Goodman, Adrian Hirsch, Longhi, Michael, Gurwith, Marc
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 18.04.2012; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; Adolescent; Adult; AIDS; AIDS vaccines; Amphetamines; Central nervous system agents; Cities; Clinical trials; Combined vaccines; Demographics; Demography; Development and progression; Disease control; Disease prevention; Disease transmission; Hazards; Health risk assessment; Health risks; HIV; HIV infections; HIV Infections - epidemiology; HIV Seropositivity - epidemiology; HIV Seroprevalence; Homosexuality, Male; Human immunodeficiency virus; Humans; Identification methods; Incidence; Infections; Male; Medical research; Medical schools; Medicine; Men; Middle Aged; Prevention; Recreational use; Risk Factors; Risk taking; Seroconversion; Sex; Sexual Partners; Sexually transmitted diseases; Sexually Transmitted Diseases - epidemiology; STD; Studies; United States - epidemiology; United States - ethnology; Vaccine efficacy; Vaccines; Young Adult; Atlanta Georgia; San Francisco California; Georgia; California; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0034972

To provide HIV seroincidence data among men who have sex with men (MSM) in the United States and to identify predictive factors for seroconversion. From 1998-2002, 4684 high-risk MSM, age 18-60 years, participated in a randomized, placebo-controlled HIV vaccine efficacy trial at 56 U.S. clinical trial sites. Demographics, behavioral data, and HIV status were assessed at baseline and 6 month intervals. Since no overall vaccine efficacy was detected, data were combined from both trial arms to calculate HIV incidence based on person-years (py) of follow-up. Predictors of seroconversion, adjusted hazards ratio (aHR), were evaluated using a Cox proportional hazard model with time-varying covariates. Overall, HIV incidence was 2.7/100 py and was relatively uniform across study sites and study years. HIV incidence was highest among young men and men reporting unprotected sex, recreational drug use, and a history of a sexually transmitted infection. Independent predictors of HIV seroconversion included: age 18-30 years (aHR = 2.4; 95% CI 1.4,4.0), having >10 partners (aHR = 2.4; 95% CI 1.7,3.3), having a known HIV-positive male sex partner (aHR = 1.6; 95% CI 1.2, 2.0), unprotected anal intercourse with HIV positive/unknown male partners (aHR = 1.7; 95% CI 1.3, 2.3), and amphetamine (aHR = 1.6; 95% CI 1.1, 2.1) and popper (aHR = 1.7; 95% CI 1.3, 2.2) use. HIV seroincidence was high among MSM despite repeated HIV counseling and reported declines in sexual risk behaviors. Continuing development of new HIV prevention strategies and intensification of existing efforts will be necessary to reduce the rate of new HIV infections, especially among young men.