National Centre in HIV Epidemiology and Clinical Research, Faculty of Medicine, The University of New South Wales, Sydney, Australia.
Sex Transm Dis. 2010 Jan;37(1):13-7. doi: 10.1097/OLQ.0b013e3181b35549.
Serosorting, the practice of seeking to engage in unprotected anal intercourse with partners of the same HIV status as oneself, has been increasing among men who have sex with men. However, the effectiveness of serosorting as a strategy to reduce HIV risk is unclear, especially since it depends on the frequency of HIV testing.
We estimated the relative risk of HIV acquisition associated with serosorting compared with not serosorting by using a mathematical model, informed by detailed behavioral data from a highly studied cohort of gay men.
We demonstrate that serosorting is unlikely to be highly beneficial in many populations of men who have sex with men, especially where the prevalence of undiagnosed HIV infections is relatively high. We find that serosorting is only beneficial in reducing the relative risk of HIV transmission if the prevalence of undiagnosed HIV infections is less than approximately 20% and approximately 40%, in populations of high (70%) and low (20%) treatment rates, respectively, even though treatment reduces the absolute risk of HIV transmission. Serosorting can be expected to lead to increased risk of HIV acquisition in many settings. In settings with low HIV testing rates serosorting can more than double the risk of HIV acquisition.
Therefore caution should be taken before endorsing the practice of serosorting. It is very important to continue promotion of frequent HIV testing and condom use, particularly among people at high risk.
血清学匹配，即寻求与自身 HIV 感染状况相同的性伴侣进行无保护的肛交，在男男性行为者中越来越普遍。然而，血清学匹配作为降低 HIV 风险的策略的有效性尚不清楚，特别是因为它取决于 HIV 检测的频率。
我们使用数学模型，根据一个经过深入研究的男同性恋队列的详细行为数据，估计了与不进行血清学匹配相比，血清学匹配与 HIV 感染获得相关的相对风险。
我们证明，在许多男男性行为者人群中，血清学匹配不太可能非常有益，特别是在未确诊的 HIV 感染率相对较高的情况下。我们发现，只有在未确诊的 HIV 感染率低于约 20%和 40%时，血清学匹配才有利于降低 HIV 传播的相对风险，分别在高（70%）和低（20%）治疗率的人群中，尽管治疗降低了 HIV 传播的绝对风险。在许多情况下，血清学匹配可能会导致 HIV 感染风险增加。在 HIV 检测率较低的情况下，血清学匹配会使 HIV 感染的风险增加一倍以上。
因此，在支持血清学匹配的做法之前应谨慎行事。继续推广频繁的 HIV 检测和使用安全套非常重要，特别是在高危人群中。
