Center for Infectious Diseases Control, National Institute for Public Health and the Environment (RIVM), Bilthoven.
Department of Infectious Diseases, Research and Prevention, Public Health Service Amsterdam.
AIDS. 2018 Jun 1;32(9):1185-1192. doi: 10.1097/QAD.0000000000001803.
Sexual risk behaviour changes during a person's life course. Insights in sexual risk behaviour trajectories of MSM may provide starting points for the timing of HIV prevention methods. We aimed to study longitudinal trajectories of sexual risk behaviour predictive of HIV acquisition from sexual debut onwards.
A longitudinal study among 815 HIV-negative participants of the Amsterdam Cohort Studies (ACS) who completed extensive questionnaires about their sexual behaviour every 6 months between 2007 and 2017.
A comprehensive behavioural risk score predictive of HIV seroconversion was developed. On the basis of this risk score, linear trajectories of sexual risk behaviour and MSM group membership were estimated using latent class growth mixture modelling. Associations between longitudinal trajectories and demographic and psychosocial factors were examined.
Three trajectories of sexual risk behaviour were identified, which were labelled Low risk (90.3% of the sample), Falling high risk (6.5%) and Rising high risk (3.3%). MSM following the Falling high risk (20.5%) and Rising high risk (25.0%) trajectories were more likely to acquire HIV during follow-up. The Falling high risk trajectory was associated with younger age at sexual debut, fewer steady partnerships and high percentages of substance use. The Rising high-risk trajectory was associated with increasing percentages of substance use over time.
MSM follow different trajectories of changing sexual risk behaviour over time. Early identification of MSM following a trajectory of falling or rising high-risk behaviour and adequate timing of individual-based preventive interventions may reduce HIV transmission.
个人生命历程中的性行为风险会发生变化。了解男男性行为者（MSM）的性行为风险轨迹，可能为确定艾滋病病毒（HIV）预防方法的时机提供切入点。本研究旨在从性初体验开始，研究预测 HIV 感染的性行为风险轨迹的纵向变化。
对阿姆斯特丹队列研究（ACS）的 815 名 HIV 阴性参与者进行了一项纵向研究，这些参与者在 2007 年至 2017 年期间，每 6 个月完成关于性行为的详细问卷。
建立了一个预测 HIV 血清转换的综合行为风险评分。基于该风险评分，使用潜在类别增长混合模型估计性行为风险和 MSM 群体成员身份的纵向轨迹。研究了纵向轨迹与人口统计学和心理社会因素之间的关联。
确定了三种性行为风险轨迹，分别为低风险（样本的 90.3%）、下降高风险（6.5%）和上升高风险（3.3%）。在随访期间，遵循下降高风险（20.5%）和上升高风险（25.0%）轨迹的 MSM 更有可能感染 HIV。下降高风险轨迹与性初体验年龄较小、稳定伴侣较少和较高的物质使用百分比有关。上升高风险轨迹与随时间推移物质使用百分比的增加有关。
MSM 随时间推移呈现不同的性行为风险变化轨迹。早期识别出遵循下降或上升高风险行为轨迹的 MSM，并适时实施基于个体的预防干预措施，可能会减少 HIV 的传播。
