Esser Stefan, Krotzek Judith, Dirks Henrike, Scherbaum Norbert, Schadendorf Dirk
Department of Dermatology and Venereology, Outpatient Clinic for HIV and STIs, University Medical Center Duisburg-Essen, Essen, Germany.
Children's Hospital Datteln, University Witten/Herdecke, Germany.
J Dtsch Dermatol Ges. 2017 Apr;15(4):421-428. doi: 10.1111/ddg.13217. Epub 2017 Mar 15.
Rising incidence rates of HIV and STIs (sexually transmitted infections) among MSM (men who have sex with men) in Germany since 2001 call for new approaches in medical prevention. The present study addresses appropriate parameters to identify those HIV-positive MSM who are at high risk for transmitting HIV and STIs.
Over a two-year period, 223 HIV-positive MSM attending the HIV outpatient clinic at the University Medical Center Essen (Germany) were systematically surveyed with respect to their sexual behavior, substance abuse, and psychological well-being in the preceding year. Data analyzed included laboratory and clinical data from the time of the initial HIV diagnosis until January 2014.
In HIV-positive MSM, a history of substance abuse, promiscuity, younger age, and known STIs was associated with a greater incidence of unprotected sexual intercourse and STIs. Apart from a detectable viral load, additional HIV-specific parameters associated with an increased HIV transmission risk included untreated HIV infection, adherence problems, changes in antiretroviral treatment over the preceding twelve months, known multiresistant HIV infection, and a higher CD 4 nadir. Despite routine quarterly monitoring of viral loads - the result thereof was communicated to patients - only 60 % of individuals assessed their HIV transmission risk correctly.
In HIV-positive MSM, patient history and routine laboratory tests allow for the establishment of patient profiles that suggest sexual behavior associated with a high risk of HIV and STI transmission, thus offering new approaches for medical prevention.
自2001年以来，德国男男性行为者（MSM）中艾滋病毒和性传播感染（STIs）的发病率不断上升，这就需要采用新的医学预防方法。本研究探讨了合适的参数，以识别那些有高艾滋病毒传播风险的艾滋病毒阳性男男性行为者。
在两年时间里，对德国埃森大学医学中心艾滋病毒门诊的223名艾滋病毒阳性男男性行为者，就其前一年的性行为、药物滥用和心理健康状况进行了系统调查。分析的数据包括从最初艾滋病毒诊断到2014年1月期间的实验室和临床数据。
在艾滋病毒阳性男男性行为者中，药物滥用史、滥交、年龄较小以及已知的性传播感染与无保护性行为和性传播感染的较高发病率相关。除了可检测到的病毒载量外，与艾滋病毒传播风险增加相关的其他艾滋病毒特异性参数包括未治疗的艾滋病毒感染、依从性问题、过去十二个月内抗逆转录病毒治疗的变化、已知的多重耐药艾滋病毒感染以及较低的CD4最低点。尽管对病毒载量进行了常规的季度监测——并将结果告知了患者——但只有60%的个体正确评估了他们的艾滋病毒传播风险。
在艾滋病毒阳性男男性行为者中，患者病史和常规实验室检查有助于建立患者档案，这些档案提示了与艾滋病毒和性传播感染高传播风险相关的性行为，从而为医学预防提供了新方法。
