Sanchez Jorge, Lama Javier R, Peinado Jesus, Paredes Andres, Lucchetti Aldo, Russell Kevin, Kochel Tadeusz, Sebastian Jose L
Investigaciones Medicas en Salud, Lima, Peru.
J Acquir Immune Defic Syndr. 2009 May 1;51 Suppl 1(Suppl 1):S47-51. doi: 10.1097/QAI.0b013e3181a2671d.
In the Andean Region, HIV and sexually transmitted infections (STI) are most prevalent among men who have sex with men (MSM), but incidence estimates and associated factors have never been prospectively assessed.
A cohort of 1,056 high-risk HIV-negative MSM in Lima, Peru, were recruited during 1998-2000 (the ALASKA Cohort), and a nested case-control analysis was conducted between seroconverters and nonseroconverters, matched 1:3 by age and duration of follow-up for comparison of risk behaviors, acute retroviral symptoms, circumcision, and STI.
During average follow-up of 335 days, 34 men seroconverted, providing a HIV incidence estimate of 3.5 per 100 person-years [95% confidence interval (CI): 2.3 to 4.7]. High syphilis (8.4 per 100 person-years, 95% CI: 6.7 to 10.1) and herpes simplex virus type 2 (HSV-2) infection (10.4 per 100 person-years, 95% CI: 8.6 to 11.9) incidence estimates were obtained. HIV seroconverters were more likely than men who remained seronegative to report fever >or=3 days (46% vs. 7%), to seek medical care (62% vs. 27%), and to have >or=1 casual partner (86.2% vs. 74.1%) since their last visit. HIV seroconverters also were more likely to have acquired syphilis or HSV-2 infection (31% vs. 8% among initially HSV-2-seronegative men) although they were less likely to be circumcised (4.2% vs. 20.6%, a nonsignificant difference). In multivariate analysis, incident syphilis or HSV-2 infection (odds ratio [OR]: 5.9, 95% CI: 1.5 to 22.7) and sex with any casual partner (OR: 4.8, 95% CI: 0.9 to 26.2) were associated with HIV seroconversion.
STI that may cause anogenital ulcers are important risk factors for HIV acquisition among high-risk MSM in Lima, a population with a very high HIV incidence estimate. Synergistic interventions focusing in preventing both HIV and HSV-2, like male circumcision, are warranted to be assessed, especially in MSM populations with low levels of circumcision and high incidence estimates of ulcerative STI.
在安第斯地区，艾滋病毒和性传播感染（STI）在男男性行为者（MSM）中最为普遍，但发病率估计值及相关因素从未进行过前瞻性评估。
1998年至2000年期间，在秘鲁利马招募了1056名高危HIV阴性的男男性行为者队列（阿拉斯加队列），并在血清转化者和未血清转化者之间进行了巢式病例对照分析，按年龄和随访时间1:3匹配，以比较危险行为、急性逆转录病毒症状、包皮环切术和性传播感染情况。
在平均335天的随访期间，34名男性发生血清转化，HIV发病率估计为每100人年3.5例[95%置信区间（CI）：2.3至4.7]。获得了梅毒（每100人年8.4例，95%CI：6.7至10.1）和2型单纯疱疹病毒（HSV-2）感染（每100人年10.4例，95%CI：8.6至11.9）的发病率估计值。与仍为血清阴性的男性相比，HIV血清转化者更有可能报告发热≥3天（46%对7%）、寻求医疗护理（62%对27%）以及自上次就诊以来有≥1个临时伴侣（86.2%对74.1%）。HIV血清转化者也更有可能感染梅毒或HSV-2（在最初HSV-2血清阴性的男性中为31%对8%），尽管他们接受包皮环切术的可能性较小（4.2%对20.6%，差异无统计学意义）。在多变量分析中，梅毒或HSV-2感染新发（比值比[OR]：5.9，95%CI：1.5至22.7）以及与任何临时伴侣发生性行为（OR：4.8，95%CI：0.9至26.2）与HIV血清转化相关。
可能导致肛门生殖器溃疡的性传播感染是利马高危男男性行为者中感染艾滋病毒的重要危险因素，该人群的艾滋病毒发病率估计非常高。有必要评估聚焦于预防艾滋病毒和HSV-2的协同干预措施，如男性包皮环切术，尤其是在包皮环切率低且溃疡性性传播感染发病率估计高的男男性行为人群中。
