Public Health England, London, United Kingdom.
Euro Surveill. 2015 Apr 16;20(15):21093. doi: 10.2807/1560-7917.es2015.20.15.21093.
HIV seroadaptive behaviours may have contributed to greater sexually transmitted infection (STI) transmission in HIV-positive men who have sex with men(MSM) and to the global increase in STIs. Using multiple national surveillance data sources and population survey data, we estimated the risk of STIs in HIV-positive MSM and assessed whether transmission in HIV-positive MSM has contributed to recent STI epidemics in England. Since 2009, an increasing proportion of STIs has been diagnosed in HIV-positive MSM, and currently, the population rate of acute bacterial STIs is up to four times that of HIV-negative or undiagnosed MSM. Almost one in five of all diagnosed HIV-positive MSM in England had an acute STI diagnosed in 2013. From 2009 to 2013, the odds of being diagnosed with syphilis increased from 2.71 (95% confidence interval (CI) 2.41–3.05, p<0.001) to 4.05 (95%CI 3.70-4.45, p<0.001) in HIV-positive relative to HIV negative/undiagnosed MSM. Similar trends were seen for gonorrhoea and chlamydia. Bacterial STI re-infection rates were considerably higher in HIV-positive MSM over a five-year follow-up period, indicative of rapid transmission in more dense sexual networks.These findings strongly suggest that the sexual health of HIV-positive MSM in England is worsening, which merits augmented public health interventions and continued monitoring.
HIV 血清适应性行为可能导致 HIV 阳性男男性行为者(MSM)中的性传播感染(STI)传播增加,并导致全球 STI 增加。我们使用多个国家监测数据源和人口调查数据,估计了 HIV 阳性 MSM 中的 STI 风险,并评估了 HIV 阳性 MSM 中的传播是否导致了英国最近的 STI 流行。自 2009 年以来,HIV 阳性 MSM 中诊断出的 STI 比例不断增加,目前,急性细菌性 STI 的人群发病率高达 HIV 阴性或未确诊 MSM 的四倍。2013 年,英国所有诊断出的 HIV 阳性 MSM 中,近五分之一的人被诊断出患有急性 STI。从 2009 年到 2013 年,与 HIV 阴性/未确诊的 MSM 相比,HIV 阳性 MSM 中梅毒的诊断几率从 2.71(95%置信区间(CI)2.41-3.05,p<0.001)增加到 4.05(95%CI 3.70-4.45,p<0.001)。淋病和衣原体也出现了类似的趋势。在五年的随访期间,HIV 阳性 MSM 的细菌性 STI 再感染率明显更高,表明在更密集的性网络中传播速度更快。这些发现强烈表明,英国 HIV 阳性 MSM 的性健康状况正在恶化,这需要加强公共卫生干预措施并持续监测。