Buchacz Kate, Armon Carl, Tedaldi Ellen, Palella Frank J, Novak Richard M, Ward Douglas, Hart Rachel, Durham Marcus D, Brooks John T
Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
Cerner Corporation, Kansas City, Missouri.
AIDS Res Hum Retroviruses. 2018 Apr;34(4):357-364. doi: 10.1089/AID.2017.0162. Epub 2018 Feb 13.
Maximizing the rates of virologic suppression (VS) among gay, bisexual, and other men who have sex with men (MSM) is essential to limiting HIV morbidity and sexual transmission of HIV in the United States. We analyzed data for MSM of non-Hispanic white (white), non-Hispanic black (black), or Hispanic/Latino race/ethnicity in the HIV Outpatient Study (HOPS) at nine U.S. HIV clinics. VS (HIV RNA <50 copies/ml) was measured closest to January 1, 2015. We modeled factors associated with VS among persons prescribed antiretroviral therapy (ART) for ≥6 months and assessed VS for a subset of participants with behavioral interview data. Among 1,303 MSM studied, 24% were black and 11% were Hispanic/Latino. Fewer black than white or Hispanic/Latino MSM had any documented ART use history (92% vs. 99% and 94%, respectively), and fewer had VS (72% vs. 91% and 81%), < .001. In analyses of MSM prescribed ART, which adjusted for insurance type, duration of ART use, and CD4 cell count, blacks had lower prevalence of VS than whites [adjusted prevalence ratio (PR) 0.87, confidence interval (95% CI) 0.81-0.93] and Hispanics/Latinos did not (PR 0.95, 95% CI 0.88-1.02). Among 331 MSM with interview data, 6% had no VS, but reported anal sex without a condom with an HIV-uninfected or unknown HIV serostatus male partner in the past 6 months. In this study of HIV-infected MSM, blacks had a significantly lower prevalence of VS than white men. Optimizing HIV care and prevention among all MSM will require addressing underlying risk factors and social determinants of health that contribute to racial/ethnic disparities in HIV outcomes.
在美国，使男同性恋者、双性恋者及其他与男性发生性行为的男性（MSM）中的病毒学抑制（VS）率最大化对于限制HIV发病率和HIV的性传播至关重要。我们分析了美国9家HIV门诊的HIV门诊研究（HOPS）中，非西班牙裔白人（白人）、非西班牙裔黑人（黑人）或西班牙裔/拉丁裔种族/族裔的MSM的数据。VS（HIV RNA<50拷贝/毫升）在最接近2015年1月1日时进行测量。我们对接受抗逆转录病毒治疗（ART）≥6个月的人群中与VS相关的因素进行建模，并对一部分有行为访谈数据的参与者评估VS情况。在研究的1303名MSM中，24%为黑人，11%为西班牙裔/拉丁裔。有任何ART使用记录史的黑人MSM比白人或西班牙裔/拉丁裔MSM更少（分别为92%对99%和94%），且实现VS的更少（72%对91%和81%），P<0.001。在对接受ART治疗的MSM的分析中，校正了保险类型、ART使用时长和CD4细胞计数后，黑人的VS患病率低于白人[校正患病率比（PR）0.87，置信区间（95%CI）0.81 - 0.93]，而西班牙裔/拉丁裔则没有（PR 0.95，95%CI 0.88 - 1.02）。在331名有访谈数据的MSM中，6%没有实现VS，但报告在过去6个月里与HIV未感染或HIV血清学状态未知的男性伴侣进行过无保护肛交。在这项对HIV感染的MSM的研究中，黑人的VS患病率显著低于白人男性。优化所有MSM中的HIV护理和预防将需要解决导致HIV结局种族/族裔差异的潜在风险因素和健康的社会决定因素。
