Antiretroviral drug resistance and risk behavior among recently HIV-infected men who have sex with men

OBJECTIVES: Examine associations among behaviors including substance use during sexual encounters, and transmitted HIV drug resistance in recently HIV-infected men who have sex with men (MSM). METHODS: Between 2002 and 2006, 117 recently HIV-infected MSM completed questionnaires regarding their 3 most recent sexual partners. Serum samples were tested for the presence of genotypic and phenotypic HIV drug resistance. Logistic regression analysis was used to assess the association of substance use, behaviors, and resistance to at least 1 class of HIV drugs. RESULTS: The mean age of participants was 35 years; 71% identified as white and 19% as Hispanic. Sixty (51%) reported substance use during sexual activity in the past 12 months. A total of 12.5% of 112 had genotypic drug resistance to at least 1 class of antiretroviral medications, and 14% of 117 had phenotypic drug resistance. Substances used during sexual activity associated with phenotypic drug resistance in multivariate models included any substance use (adjusted odds ratio [aOR] = 4.21, 95% confidence interval [CI]: 1.13 to 15.68), polysubstance use (aOR = 5.64, 95% CI: 1.62 to 19.60), methamphetamine (aOR = 4.00, 95% CI: 1.19 to 13.38), 3,4-methylenedioxy-N-methylamphetamine (MDMA)/Ecstasy (aOR = 7.16, 95% CI: 1.40 to 36.59), and gamma-hydroxyl butyrate (GHB) (aOR = 6.98, 95% CI: 1.82 to 26.80). The genotype analysis was similar. CONCLUSIONS: Among these recently HIV-infected MSM, methamphetamine use during sexual activity and use of other substances, such as MDMA and GHB, was associated with acquired drug-resistant virus. No other behaviors associated with acquisition of drug-resistant HIV.     

Transmission behaviors of recently HIV-infected men who have sex with men

OBJECTIVES: Analyze postdiagnosis behaviors of recently HIV-infected men who have sex with men (MSM). METHODS: Recently HIV-infected MSM were interviewed at 6 weeks (n = 153) and 3 months (n = 113) after diagnosis. Behaviors from baseline to follow-up were compared; multivariate logistic regression identified associations between baseline characteristics and behavior at follow-up. RESULTS: At follow-up, MSM reported a significantly lower mean of partners (7.9 vs. 5.2) and lower means of 1-time (1.9 vs. 0.8), unknown (3.7 vs. 2.6), and acquaintance (1.1 vs. 0.5) partners than at baseline. In multivariate analyses, unprotected anal intercourse (UAI) with the last partner at follow-up was more likely if the last partner at baseline was a main partner (odds ratio [OR] = 2.94, 95% confidence interval [CI]: 1.04 to 8.33) or HIV-positive partner (OR = 3.36, 95% CI: 1.27 to 8.88) but less likely if, at follow-up, the last partner was HIV-negative (OR = 0.28, 95% CI: 0.08 to 1.00) or of unknown HIV status (OR = 0.23, 95% CI: 0.08 to 0.71), the participant had a history of nonconsensual sex (OR = 0.25, 95% CI: 0.09 to 0.72), or the participant had more than 1 partner (OR = 0.28, 95% CI: 0.09 to 0.86). More than 1 partner at follow-up was associated with no main partner at baseline or follow-up (OR = 2.76, 95% CI: 1.12 to 6.78), more partners in the last 12 months (OR = 1.02, 95% CI: 1.01 to 1.04), and UAI with the last partner (OR = 0.36, 95% CI: 0.14 to 0.90). CONCLUSIONS: After diagnosis, some but not all recently HIV-infected MSM reduced risky sexual behavior permitting potential HIV transmission.     

Predicting HIV transmission risk among HIV-infected men who have sex with men: findings from the healthy living project

OBJECTIVE: To examine the predictors of transmission risk among HIV-infected men who have sex with men (MSM) in 4 US cities. METHOD: Individual computer-assisted interviews assessing psychologic measures and sexual behavior with the 5 most recent male and female partners were conducted with a diverse sample of 1910 HIV-infected MSM recruited from community and clinic settings in San Francisco, New York, Los Angeles, and Milwaukee. Transmission-risk events were defined as unprotected vaginal or anal sex with a partner who was HIV negative or of unknown status. RESULTS: A small but not insignificant proportion of MSM (12.7%) reported at least 1 transmission-risk event in the previous 3 months, with 57% of those events taking place with casual as opposed to steady partners. Multivariate predictors of transmission risk with casual partners were stimulant (eg, crystal methamphetamine) and other drug use, having low coping self-efficacy, and not having disclosed one's HIV serostatus to all partners. Stimulant use and failing to disclosing one's serostatus to all partners were associated with risk in primary relationships. CONCLUSIONS: Responding to HIV transmission risk in MSM requires different strategies for primary and casual partners.     

Risk factors for missed HIV primary care visits among men who have sex with men

Benefits of anti-retroviral therapy (ART) depend on consistent HIV care attendance. However, appointment non-adherence (i.e. missed appointments) is common even in programs that reduce financial barriers. Demographic, health/treatment, and psychosocial contributors to appointment non-adherence were examined among men who have sex with men (MSM) attending HIV primary care. Participants (n = 503) completed questionnaires, and HIV biomarker data were extracted from medical records. At 12 months, records were reviewed to assess HIV primary care appointment non-adherence. Among MSM, 31.2% missed without cancellation at least one appointment during 12-month study period. Independent predictors (P < 0.05) were: low income (OR = 1.87); African American (OR = 3.00) and Hispanic/Latino (OR = 4.31) relative to non-Hispanic White; depression (OR = 2.01); and low expectancy for appointments to prevent/treat infection (OR = 2.38), whereas private insurance (OR = 0.48) and older age (OR = 0.94) predicted lower risk. Low self-efficacy predicted marginal risk (OR = 2.74, P = 0.10). The following did not independently predict risk for non-adherence: education, relationship status, general health, time since HIV diagnosis, ART history, post-traumatic stress disorder, HIV stigma, or supportive clinic staff. Appointment non-adherence is prevalent, particularly among younger and racial/ethnic minority MSM. Socioeconomic barriers, depression and low appointment expectancy and self-efficacy may be targets to increase care engagement.     

Oral human papillomavirus type-specific infection in HIV-infected men: a prospective cohort study among men who have sex with men and heterosexual men

The natural history of type-specific oral infection of human papillomavirus (HPV) was assessed in a cohort of HIV-infected men (538 men who have sex with men (MSM); 195 heterosexuals). Risk factors associated with oral HPV infections were examined. The overall prevalence of HPV was 16%: HPV-16 was the most prevalent type (3.7% MSM; 7.8% heterosexuals). The prevalence of HPV-16 in heterosexuals was associated with CD4 nadir counts <200 cells/μL (OR_adjusted = 3.0, 95% CI, 1.4–6.3). The overall incidence of HPV was similar between groups (11%), but the incidence of HPV-16 was higher in heterosexuals (OR_adjusted = 3.2, 95% CI, 1.1–9.5). Not only MSM but also HIV-infected heterosexual men are at risk of HPV infection. Regular and careful oral inspection is needed.     

The HIV epidemic among older men who have sex with men

The authors present HIV prevalence and risk behavior data for urban men who have sex with men (MSM) aged 50 years or older. Data are based on a probability sample of MSM conducted in 1997 (n = 2881 total; 507 older MSM) in New York, Los Angeles, Chicago, and San Francisco. The authors determined HIV status through self-report and biologic measures. Risk behavior was assessed through self-report. The authors found that HIV prevalence was 19% (95% CI: 14, 25) for men in their 50s and 3% (95% CI: 1, 10) for men in their 60s. No men in their 70s were HIV-positive. Prevalence was at high levels for older blacks (30%), MSM who are injection drug users (21%), moderately heavy drug users (35%), and less closeted men (21%). High-risk sex between serodiscordant partners was relatively constant (4%-5%) across age groups older than 30 years of age and decreased among MSM in their 70s. Current levels of HIV among older urban MSM in the United States are very high, particularly among those in their 50s. High mortality rates among MSM with AIDS up to 1996 (before highly active antiretroviral therapy [HAART]) would account for the lower levels among men in their 60s and 70s. Because of HAART, we would expect HIV levels to increase in these age groups. Given high levels of risk behavior among MSM through the sixth decade of life, the authors would expect an older MSM epidemic of substantially larger proportion than that observed in the 1980s and 1990s.     

HIV阳性男男同性性行为者的执行功能及自评抑郁

目的:探讨HIV阳性男男同性性行为者(MSM)执行功能、自评抑郁的特征及两者的关系。方法:选取HIV感染MSM的患者209例及年龄、受教育程度匹配的HIV阴性MSM 84例。用威斯康星卡片分类测验64张卡片版(WCST-64)评估执行功能,流调中心抑郁量表(CES-D)评估抑郁状态。结果:HIV阳性MSM的WCST-64错误应答数、随机错误数高于HIV阴性MSM,完成分类数低于HIV阴性MSM(均P<0.05)。HIV阳性MSM中,抑郁组WCST-64错误应答数高于无抑郁组,概念化水平百分数低于无抑郁组(均P<0.05)。多元回归分析显示,HIV阳性MSM的年龄、CES-D得分与WCST-64错误应答数正向关联(β=0.33、0.15)、最低CD4+T细胞数与WCST-64错误应答数负向关联(β=-0.15)。结论:HIV阳性男男同性性行为者的执行功能低于HIV阴性者,且与抑郁状态负相关。     

Mental health and HIV risk in men who have sex with men

Evidence-based HIV prevention interventions with men who have sex with men (MSM) in the United States have moderate effect sizes in reducing HIV sexual risk behavior. Mental health and psychosocial problems, which both disproportionately affect MSM populations and are implicated in HIV transmission risk behaviors, also likely interfere with the uptake of HIV behavioral interventions. Moreover, given that mental health and psychosocial problems such as depression, substance use, and violence frequently co-occur for many MSM (eg, as syndemic conditions), what is probably needed are combination prevention efforts, or prevention "cocktails," similar to treatment "cocktails," that address the psychological and behavioral mechanisms that interact to produce elevated risk for HIV. Such interventions should incorporate a holistic framework to address the sexual health and overall well being of MSM. Addressing co-occurring psychosocial risk factors is apt to improve effect sizes of current HIV prevention interventions and allow for more effective uptake by MSM.     

Non-consensual sex experienced by men who have sex with men: prevalence and association with mental health

Little is known about the psychosocial factors associated with sexual assault experienced by males. Men (N=358), 19-35 years of age, recruited by community outreach, completed questionnaires. Eligibility criteria included: being HIV-negative and self-identifying as gay or bisexual. Lifetime prevalence rates of childhood sexual abuse, juvenile prostitution, and adult sexual assault were determined. The mental health of this population was explored including associations between sexual victimization and mental health disorders (alcohol abuse, suicidal ideation and attempts, mood disorders, and poor self-esteem). Almost 1 in 10 of the men had engaged in juvenile prostitution, 14% were forced into sexual activity before 14 years of age, and 14% were sexually victimized after the age of 14. Those exposed to non-consensual sex were 2.9 (95% CI: 1.8-4.7) times more likely to abuse alcohol than those free of victimization. Those who reported childhood sexual abuse were 3.3 (95% CI: 1.7-6.4) times more likely to have attempted suicide. Juvenile prostitution was associated with current depression (OR=6.4; 95% CI: 2.8-14.9). Health professionals have the responsibility to respond competently and sensitively to victims of sexual violence. To do this, many need to recognize the prevalence of male sexual trauma, to deconstruct their personal beliefs about same-sex sexual violence, and to learn to ask sensitive questions in their assessment interviews.     

Elevated syringe borrowing among men who have sex with men: a prospective study

OBJECTIVE: Despite efforts to scale up HIV prevention services for drug users, high rates of HIV risk behavior persist among some subpopulations. Given that few prospective studies have considered the relationship between sexual activity and syringe sharing, we sought to evaluate syringe sharing among male injection drug users (IDUs) who have sex with men (MSM) in Vancouver. METHODS: We performed a longitudinal analysis of factors associated with syringe borrowing among male participants enrolled in the Vancouver Injection Drug Users Study during the years 1996 to 2005 using generalized estimating equations (GEE). RESULTS: Among the 1019 male participants included in this analysis, 553 (54.3%) reported borrowing syringes during the study period. In multivariate GEE analysis, MSM were at an elevated risk for syringe borrowing (adjusted odds ratio [AOR] = 1.50, 95% confidence interval [CI]: 1.10 to 2.04) after extensive adjustment for other known risk factors. CONCLUSIONS: Among male participants, having sex with men was found to be strongly and independently associated with syringe borrowing. Our findings may aid policy makers in their efforts to identify IDUs who should be targeted with education and prevention efforts, and indicate the need for ongoing development of prevention interventions that address sexual orientation.     

Cognitive coping, goal self-efficacy and personal growth in HIV-infected men who have sex with men

OBJECTIVE: The relationships between cognitive coping strategies, goal self-efficacy and personal growth were studied in HIV-positive men who have sex with men. METHODS: All members of a national organization for people living with HIV received a call for participation. The Cognitive Emotion Regulation Questionnaire, the Goal Obstruction Questionnaire and the Personal Growth Scale were filled out at home by 104 HIV-infected men. RESULTS: Thinking about joyful and pleasant issues instead of thinking about being HIV-positive, thinking about what steps to take and how to handle being HIV-positive, thoughts of attaching a positive meaning to being HIV-positive, thoughts of playing down the seriousness of being HIV-positive or emphasizing its relativity when compared to other events, thoughts of putting the blame of being HIV-positive on others (inversely) and the extent to which one considers oneself able to reengage in alternative meaningful goals were related to personal growth. CONCLUSION: The study showed that both cognitive coping strategies and goal self-efficacy were related to personal growth. The findings suggest that mainly positive ways to handle being HIV-infected are related to personal growth. PRACTICE IMPLICATIONS: These findings suggested that intervention programs for people with HIV should pay attention to cognitive coping strategies and goal self-efficacy.     

Using novel methods to examine stress among HIV-positive African American men who have sex with men and women

Biomarker composites (BCs) that objectively quantify psychosocial stress independent of self report could help to identify those at greatest risk for negative health outcomes and elucidate mechanisms of stress-related processes. Here, BCs are examined in the context of existing disease progression among HIV-positive African American men who have sex with men and women (MSMW) with high stress histories, including childhood sexual abuse. Participants (N = 99) collected 12-h overnight and morning urine samples for assay of cortisol and catecholamines (primary BC) and neopterin (an indicator of HIV disease progression). Data on cumulative psychosocial trauma history (severity, types, frequency, age at first incident), posttraumatic stress disorder (PTSD) symptoms, sexual risk behaviors, and a secondary BC consisting of routine health indicators (heart rate, blood pressure, body mass index, waist-to-hip ratio) were also collected. Lifetime trauma exposure was highly pervasive and significantly greater among those meeting a standard cutoff for PTSD caseness (24 %). After controlling for HIV factors (neopterin levels and years with disease), PTSD was a significant (p < .05) predictor of the primary, but not secondary BC. Those with PTSD also had significantly more sexual partners, sex without a condom, and exchange sex for money or drugs than those without PTSD. Specific trauma characteristics predicted PTSD severity and caseness independently and uniquely in regression models (p’s < .05–.001). A primary BC appears sensitive to cumulative trauma burden and PTSD in HIV-positive African American MSMW, providing support for the use of BCs to quantify psychosocial stress and inform novel methods for examining mechanisms of stress influenced health behaviors and disease outcomes in at-risk populations.     

Sexual risk behavior among HIV-positive men who have sex with men: a literature review

OBJECTIVE: To review research on sexual risk behavior among HIV-positive men who have sex with men (MSM) after the year 2000. METHOD: The review included 53 published studies that reported on unprotected anal intercourse (UAI) in cross-sectional and longitudinal surveys of HIV-positive MSM and MSM of mixed HIV status. RESULTS: The findings indicate high levels of UAI among HIV-positive MSM, particularly with HIV-negative or HIV status unknown partners. In studies of MSM of mixed HIV status, we found that the rate of UAI among HIV-positive MSM was much higher than that of HIV-negative MSM. Furthermore, the prevalence of UAI among HIV-positive MSM has increased in recent years. CONCLUSION: Although studies indicate that HIV-positive MSM have adopted risk reduction strategies, roughly two in five HIV-positive MSM continue to engage in UAI, which represents a risk for continued HIV and STI (sexually transmitted infection) transmission. PRACTICE IMPLICATIONS: Prevention efforts targeting HIV-positive MSM to assist them in adopting and maintaining safer sexual behaviors need to be intensified.     

Substance use among men who have sex with men: comparison with a national household survey

OBJECTIVE: Compare substance use among men who have sex with men (MSM) at high risk for HIV infection to a nationally representative sample of heterosexual men. METHODS: Compare data from surveys of 3,212 MSM recruited for participation in a Vaccine Preparedness Study (VPS) with an age-standardized group of 2481 single, urban-dwelling men from the 1995 National Household Survey on Drug Abuse (NHSDA). RESULTS: Except for alcohol, relative risk (RR [95% confidence interval (CI)]) for use of any substance was higher in the VPS than the National Household Survey on Drug Abuse (NHSDA) (3.64 [3.01-4.42]). Drugs with the highest relative risks were "poppers" (21.6 [15.2-30.8]), sedatives (6.98 [2.46-19.8]), hallucinogens (6.14 [4.61-8.17]), tranquilizers (4.99 [2.96-8.42]), and stimulants (4.47 [3.58-5.58]). RR was higher for weekly use of poppers (33.5 [12.5-89.6]), stimulants (2.75 [1.79-4.22]), marijuana (2.37 [1.93-2.92]), and cocaine (2.24 [1.32-3.79]); and for daily use of marijuana (1.49 [1.08-2.05]). CONCLUSIONS: Participants in the VPS used more substances than a group of age-standardized, single, urban-dwelling men from the NHSDA. In view of previous data showing that substance use can be associated with unprotected sex, assessing substance use among MSM at high risk for HIV infection is an important component of risk reduction efforts.     

Anal dysplasia in men who have sex with men

Risk factors for anal cancer include anal intercourse and infection with multiple strains of human papillomavirus, the causative agent of anal precancerous dysplasia. Several recent studies have shown that HIV-seropositive gay men are at greater risk for anal dysplastic lesions than seronegative gay men. Moreover, the risk for detection and progression of dysplastic lesions grows as the CD4+ cell count declines. A surgeon with a practice that includes gay men referred for anorectal disease presents data regarding the high prevalence of anal dysplasia in his patients.     

Psychosocial correlates of HIV-monoinfection and HIV/HCV-coinfection among men who have sex with men

Rates of hepatitis C virus (HCV) among HIV-positive men who have sex with men (MSM) appear to be high and rising. In other demographic groups, HIV/HCV-coinfection is associated with poor physical and psychological outcomes. In this study, we examined health-related and psychosocial correlates of HIV/HCV-coinfection in a clinic sample of MSM. Cross-sectional data were collected from 171 MSM. One-third of the sample was coinfected. Higher rates of depressive and PTSD symptoms were observed in coinfected patients. Coinfected men were more likely to report perfect 30-day medication adherence, but exhibited lower CD4 cell counts and more past year emergency room visits. Despite consistent engagement with care and higher rates of medication adherence, HIV/HCV-coinfected MSM exhibited significantly more mental health problems. Medical and mental health providers should be especially attentive to the mental health status of HIV/HCV-coinfected MSM, despite adequate health behaviors and physical health status.     

HIV infection and human herpesvirus-8 oral shedding among men who have sex with men

Human herpesvirus-8 (HHV-8) is frequently detected in oropharyngeal secretions from HIV-infected men who have sex with men (MSM), and contact with saliva may be an important mode of HHV-8 transmission. A total of 196 MSM were followed over 2 years to determine the correlates of HHV-8 oropharyngeal shedding. A total of 134 (68%) of 196 participants were HHV-8 seropositive upon enrollment, and 9 (15%) of 62 participants seroconverted to HHV-8 during follow-up. HHV-8 DNA was detected in 43 (22%) of 196 participants: 39 (27%) of 134 HHV-8 seropositive, 4 (8%) of 53 HHV-8 seronegative, and 5 (56%) of 9 seroconverters to HHV-8. HHV-8 was detected in 101 (15%) of 696 total oral specimens: 84 (17%) of 481 samples from HHV-8-seropositive men, 6 (3%) of 180 samples from HHV-8-seronegative men, and 11 (31%) of 35 samples from seroconverters. Using adjusted marginal structural models, HHV-8 shedding was higher in men not receiving highly active antiretroviral therapy (odds ratio 2.4, 95% CI 1.0-6.0, P = 0.06), with CD4 counts > 200 cells/mm (odds ratio 4.8, 95% CI 1.0-22.8, P = 0.05), or with detectable oral leukocyte esterase (odds ratio 5.0, 95% CI 2.0-12.5, P < 0.01). CD4 count, antiretroviral therapy, and oral inflammation may influence HHV-8 oropharyngeal shedding.