Dougan Sarah, Evans Barry G, Elford Jonathan
City University, Institute of Health Sciences, St. Bartholomew School of Nursing and Midwifery, London, United Kingdom.
Sex Transm Dis. 2007 Oct;34(10):783-90. doi: 10.1097/01.olq.0000260919.34598.5b.
BACKGROUND: Since 1996, there has been a resurgence in sexually transmitted infections (STIs) among men who have sex with men (MSM) in Western Europe. This has coincided with a significant decrease in HIV-associated mortality following the introduction of highly active antiretroviral therapies (HAART) and a corresponding increase in the number of MSM living with HIV. Levels of unprotected anal intercourse have also increased. In this article, we use STI surveillance data from a number of Western European countries to better understand the contribution of HIV-positive MSM to the recent increase in STIs. METHODS: Published literature, surveillance reports, and ad hoc publications relating to HIV prevalence trends and STIs among HIV-positive MSM in Western Europe were reviewed. RESULTS: Post-HAART, HIV prevalence among community samples of MSM ranged from 5% to 18%. HIV prevalence among MSM diagnosed with an STI was substantially higher. On average, HIV prevalence among MSM diagnosed with syphilis in 11 countries was 42% (range 14%-59%). Most HIV-positive MSM with syphilis were aware of their HIV status. In England and Wales, 32% of MSM with gonorrhea were HIV-positive in 2004. Outbreaks of lymphogranuloma venereum have been documented in 9 countries; HIV-positive MSM accounted for 75% of cases on average (range 0%-92%). Cases of sexually transmitted hepatitis C have been predominantly identified among HIV-positive MSM in Rotterdam, Paris, Amsterdam, and the United Kingdom. CONCLUSIONS: In Western Europe, STIs have been disproportionately diagnosed among HIV-positive MSM post-HAART. Improved survival coupled with serosorting among HIV-positive MSM appears to explain the high prevalence of HIV among MSM with STIs. STI transmission among HIV-positive men will have contributed substantially to increasing STI trends seen among MSM in Western Europe, since 1996. These findings highlight the need for routine STI testing among HIV-positive MSM as well as safer sex messages highlighting the implications of STI coinfection.
背景：自1996年以来，西欧男男性行为者（MSM）中的性传播感染（STIs）有所抬头。这与高效抗逆转录病毒疗法（HAART）引入后HIV相关死亡率显著下降以及感染HIV的MSM人数相应增加同时发生。无保护肛交的比例也有所上升。在本文中，我们利用来自多个西欧国家的性传播感染监测数据，以更好地了解HIV阳性MSM对近期性传播感染增加的影响。 方法：对已发表的文献、监测报告以及与西欧HIV阳性MSM中HIV流行趋势和性传播感染相关的专题出版物进行了综述。 结果：HAART治疗后，MSM社区样本中的HIV流行率在5%至18%之间。被诊断患有性传播感染的MSM中的HIV流行率显著更高。在11个国家，被诊断患有梅毒的MSM中HIV流行率平均为42%（范围为14% - 59%）。大多数患有梅毒的HIV阳性MSM知晓自己的HIV感染状况。在英格兰和威尔士，2004年32%的淋病MSM为HIV阳性。9个国家记录了性病性淋巴肉芽肿的疫情；HIV阳性MSM平均占病例的75%（范围为0% - 92%）。在鹿特丹、巴黎、阿姆斯特丹和英国，性传播丙型肝炎病例主要在HIV阳性MSM中被发现。 结论：在西欧，HAART治疗后，HIV阳性MSM中性传播感染的诊断比例过高。HIV阳性MSM生存率的提高以及血清分类似乎解释了患有性传播感染的MSM中HIV的高流行率。自1996年以来，HIV阳性男性之间的性传播感染传播在很大程度上导致了西欧MSM中性传播感染趋势的增加。这些发现凸显了对HIV阳性MSM进行常规性传播感染检测的必要性，以及强调性传播感染合并感染影响的安全性行为信息的必要性。
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