Castillo Rostislav, Konda Kelika A, Leon Segundo R, Silva-Santisteban Alfonso, Salazar Ximena, Klausner Jeffrey D, Coates Thomas J, Cáceres Carlos F
*School of Medicine, Stanford University, Stanford, CA; †Unit of Health, Sexuality and Human Development, Universidad Peruana Cayetano Heredia, Lima, Peru; and ‡Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA.
J Acquir Immune Defic Syndr. 2015 Aug 15;69(5):567-75. doi: 10.1097/QAI.0000000000000667.
Men who have sex with men (MSM) and male-to-female transgender women (TW) are at increased risk of HIV and sexually transmitted infections (STIs). We evaluated factors associated with incidence of HIV, HSV-2, and chlamydia and gonorrhea (anal and pharyngeal).
We used data from the Comunidades Positivas trial with MSM/TW who have sex with men in Lima, Peru. Participants were asked about sexual risk behaviors and underwent HIV/STI testing at baseline and 9- and 18-month follow-ups. We used discrete time proportional hazards regression to calculate hazard ratios for variables associated with incidence of each STI.
Among 718 MSM/TW, HIV incidence was 3.6 cases per 100 person-years. HIV incidence was associated with having an incident STI adjusted hazard ratio (aHR) of 3.73. Unprotected receptive anal intercourse was associated with incident anal chlamydia (aHR 2.20). An increased number of sexual partners increased incident HSV-2 (aHR 3.15 for 6-14 partners and 3.97 for 15-46 partners compared with 0-2 partners). The risk of anal gonorrhea decreased with each sexually active year (aHR 0.94) and increased for unprotected compensated sex (aHR 2.36). The risk of pharyngeal gonorrhea also decreased with each year since sexual debut (aHR 0.95). The risk of anal chlamydia decreased with each sexually active year (aHR 0.96); the risk increased with reports of unprotected sex work (aHR 1.61) and unprotected receptive anal sex (aHR 2.63). All aHRs have P values <0.05.
MSM/TW experience high incidence of HIV. Up-to-date prevalence and incidence information and identifying factors associated with infection can help develop a more effective combination prevention response.
男男性行为者（MSM）以及男变女跨性别女性（TW）感染艾滋病毒和性传播感染（STI）的风险增加。我们评估了与艾滋病毒、单纯疱疹病毒2型（HSV-2）以及衣原体和淋病（肛门和咽部）发病率相关的因素。
我们使用了来自秘鲁利马针对与男性发生性行为的男男性行为者/跨性别女性的Comunidades Positivas试验的数据。参与者被询问性风险行为，并在基线以及9个月和18个月随访时接受艾滋病毒/性传播感染检测。我们使用离散时间比例风险回归来计算与每种性传播感染发病率相关变量的风险比。
在718名男男性行为者/跨性别女性中，艾滋病毒发病率为每100人年3.6例。艾滋病毒发病率与发生性传播感染相关，调整后的风险比（aHR）为3.73。无保护的被动肛交与肛门衣原体感染相关（aHR 2.20）。性伴侣数量增加会增加HSV-2感染风险（与0-2个性伴侣相比，6-14个性伴侣的aHR为3.15，15-46个性伴侣的aHR为3.97）。肛门淋病风险随每年性活跃而降低（aHR 0.94），无保护的补偿性性行为会增加其风险（aHR 2.36）。自首次性行为以来，咽部淋病风险也随每年降低（aHR 0.95）。肛门衣原体感染风险随每年性活跃而降低（aHR 0.96）；无保护的性工作报告（aHR 1.61）和无保护的被动肛交（aHR 2.63）会增加其风险。所有aHR的P值均<0.05。
男男性行为者/跨性别女性艾滋病毒感染率高。最新的流行率和发病率信息以及识别与感染相关的因素有助于制定更有效的综合预防措施。
