重复艾滋病毒检测与男男性行为者行为风险增加有关：一项队列研究。

Repeat HIV-testing is associated with an increase in behavioral risk among men who have sex with men: a cohort study.

作者信息

Hoenigl Martin, Anderson Christy M, Green Nella, Mehta Sanjay R, Smith Davey M, Little Susan J

机构信息

AntiViral Research Center, Division of Infectious Diseases, Department of Medicine, University of California, San Diego, 200 West Arbor Drive #8208, San Diego, CA, 92103, USA.

Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria.

出版信息

BMC Med. 2015 Sep 11;13:218. doi: 10.1186/s12916-015-0458-5.

DOI:10.1186/s12916-015-0458-5

PMID:26444673

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4596465/

Abstract

BACKGROUND

The Center for Disease Control and Prevention recommends that high-risk groups, like sexually active men who have sex with men (MSM), receive HIV testing and counseling at least annually. The objective of this study was to investigate the relationship between voluntary repeat HIV testing and sexual risk behavior in MSM receiving rapid serologic and nucleic acid amplification testing.

METHODS

We performed a cohort study to analyze reported risk behavior among MSM receiving the "Early Test", a community-based, confidential acute and early HIV infection screening program in San Diego, California, between April 2008 and July 2014. The study included 8,935 MSM receiving 17,333 "Early Tests". A previously published risk behavior score for HIV acquisition in MSM (i.e. Menza score) was chosen as an outcome to assess associations between risk behaviors and number of repeated tests.

RESULTS

At baseline, repeat-testers (n = 3,202) reported more male partners and more condomless receptive anal intercourse (CRAI) when compared to single-testers (n = 5,405, all P <0.001). In 2,457 repeat testers there was a strong association observed between repeated HIV tests obtained and increased risk behavior, with number of male partners, CRAI with high risk persons, non-injection stimulant drug use, and sexually transmitted infections all increasing between the first and last test. There was also a linear increase of risk (i.e. high Menza scores) with number of tests up to the 17th test. In the multivariable mixed effects model, more HIV tests (OR = 1.18 for each doubling of the number of tests, P <0.001) and younger age (OR = 0.95 per 5-year increase, P = 0.006) had significant associations with high Menza scores.

CONCLUSIONS

This study found that the highest risk individuals for acquiring HIV (e.g. candidates for antiretroviral pre-exposure prophylaxis) can be identified by their testing patterns. Future studies should delineate causation versus association to improve prevention messages delivered to repeat testers during HIV testing and counseling sessions.

摘要

背景

疾病控制与预防中心建议，像男男性行为者（MSM）这类高危人群至少每年接受一次HIV检测和咨询。本研究的目的是调查接受快速血清学和核酸扩增检测的男男性行为者中自愿重复HIV检测与性风险行为之间的关系。

方法

我们进行了一项队列研究，以分析2008年4月至2014年7月期间在加利福尼亚州圣地亚哥接受“早期检测”（一项基于社区的、保密的急性和早期HIV感染筛查项目）的男男性行为者报告的风险行为。该研究纳入了8935名接受17333次“早期检测”的男男性行为者。选择先前发表的男男性行为者中HIV感染风险行为评分（即门扎评分）作为评估风险行为与重复检测次数之间关联的结果指标。

结果

在基线时，与单次检测者（n = 5405，所有P <0.001）相比，重复检测者（n = 3202）报告有更多男性性伴侣以及更多无保护的被动肛交行为（CRAI）。在2457名重复检测者中，观察到HIV重复检测次数与风险行为增加之间存在强烈关联，从首次检测到最后一次检测期间，男性性伴侣数量、与高危人群的无保护被动肛交行为、非注射类兴奋剂使用以及性传播感染均有所增加。随着检测次数增加至第17次检测，风险（即高门扎评分）也呈线性上升。在多变量混合效应模型中，更多的HIV检测（检测次数每增加一倍，OR = 1.18，P <0.001）以及更年轻的年龄（每增加5岁，OR = 0.95，P = 0.006）与高门扎评分有显著关联。