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. 2012;7(4):e34972.
doi: 10.1371/journal.pone.0034972. Epub 2012 Apr 18.

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

Marta-Louise Ackers  1 , Alan E Greenberg, Carol Y Lin, Bradford N Bartholow, Adrian Hirsch Goodman, Michael Longhi, Marc Gurwith
Affiliations

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

Marta-Louise Ackers et al. PLoS One. 2012.

Abstract

Objective: To provide HIV seroincidence data among men who have sex with men (MSM) in the United States and to identify predictive factors for seroconversion.

Methods: 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.

Results: 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.

Conclusions: 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.

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Conflict of interest statement

Competing Interests: AG, ML, and MG were employed by VaxGen, Inc., at the time this study was conducted. CL was employed by Northrop-Grumman Corporation. There are no patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials, as detailed online in the guide for authors.

Figures

Figure 1
Figure 1. HIV incidence among MSM study participants in the United States, by city, 1998–2002*.
See this image and copyright information in PMC

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