Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Int J STD AIDS. 2023 Dec;34(14):998-1003. doi: 10.1177/09564624231193491. Epub 2023 Aug 6.
Urethritis associated with non-viral sexually transmitted infections (STI) increases the risk of HIV acquisition and transmission in those living with HIV (LWH) without viral load suppression (VLS). Compared to women, men typically have lower rates of HIV VLS. We assessed the prevalence of VLS and drug resistance mutations in men LWH and urethral discharge syndrome (UDS) in Kampala, Uganda.
Men with UDS were recruited in Kampala October 2019-November 2020. Medical, demographic, and behavioural data were collected with biological samples. All reactive HIV results (rapid, sequential algorithm) underwent confirmatory HIV antibody- and HIV incidence-testing, and viral load (VL) measurement. The and regions were sequenced on samples with VLs >1000 cpm, phylogenetic trees were generated, and resistance mutations were investigated.
50 of 250 participants (20%) had reactive HIV rapid tests and 48/50 (96%) were aware of their HIV status and using antiretroviral therapy (ART). The median age was 38 years (IQR 32-45), 27/50 (54%) had engaged in transactional sex, and 30/50 (60%) reported alcohol before sex. VLS was present in 46/50 (92%). There were no major resistance mutations present in any samples analyzed.
The prevalence of HIV and VLS was greater in these men than in the general Ugandan adult population. Most men LWH were on ART and thus less likely to transmit HIV despite demonstrating sexual behaviours associated with high-risk of STIs. These data emphasize that high levels of ART coverage and VLS are achievable among men with UDS in urban Kampala.
非病毒性性传播感染（STI）引起的尿道炎会增加未抑制病毒载量（VLS）的 HIV 感染者（PLWH）获得和传播 HIV 的风险。与女性相比，男性通常 HIV VLS 率较低。我们评估了乌干达坎帕拉男性 PLWH 和尿道分泌物综合征（UDS）的 VLS 率和耐药突变率。
2019 年 10 月至 2020 年 11 月，在坎帕拉招募了患有 UDS 的男性。收集了医学、人口统计学和行为数据，并采集了生物样本。所有 HIV 快速检测呈阳性的结果（快速、序贯算法）都进行了 HIV 抗体和 HIV 感染检测的确认，并进行了病毒载量（VL）测量。对 VLs>1000 cpm 的样本进行 和 区测序，生成系统进化树，并研究耐药突变。
250 名参与者中有 50 名（20%）的 HIV 快速检测呈阳性，其中 48/50（96%）知晓自己的 HIV 状况并正在使用抗逆转录病毒疗法（ART）。中位年龄为 38 岁（IQR 32-45），27/50（54%）有过交易性性行为，30/50（60%）在性行为前饮酒。50 名参与者中有 46 名（92%）存在 VLS。在分析的所有样本中均未发现主要耐药突变。
这些男性的 HIV 和 VLS 患病率高于乌干达一般成年人群。尽管大多数男性 PLWH 正在接受 ART，因此不太可能传播 HIV，但他们表现出的性行为与性传播感染的高危行为相关。这些数据强调，在城市坎帕拉，对 UDS 男性进行高 ART 覆盖率和 VLS 是可行的。
