Measuring Population Transmission Risk for HIV: An Alternative Metric of Exposure Risk in Men Who Have Sex with Men (MSM) in the US
Open Access
- 28 December 2012
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 7 (12), e53284
- https://doi.org/10.1371/journal.pone.0053284
Abstract
Various metrics for HIV burden and treatment success [e.g. HIV prevalence, community viral load (CVL), population viral load (PVL), percent of HIV-positive persons with undetectable viral load] have important public health limitations for understanding disparities. Using data from an ongoing HIV incidence cohort of black and white men who have sex with men (MSM), we propose a new metric to measure the prevalence of those at risk of transmitting HIV and illustrate its value. MSM with plasma VL>400 copies/mL were defined as having ‘transmission risk’. We calculated HIV prevalence, CVL, PVL, percent of HIV-positive with undetectable viral loads, and prevalence of plasma VL>400 copies/ml (%VL400) for black and white MSM. We used Monte Carlo simulation incorporating data on sexual mixing by race to estimate exposure of black and white HIV-negative MSM to a partner with transmission risk via unprotected anal intercourse (UAI). Of 709 MSM recruited, 42% (168/399) black and 14% (44/310) white MSM tested HIV-positive (p<.0001). No significant differences were seen in CVL, PVL, or percent of HIV positive with undetectable viral loads. The %VL400 was 25% (98/393) for black vs. 8% (25/310) for white MSM (p<.0001). Black MSM with 2 UAI partners were estimated to have 40% probability (95% CI: 35%, 45%) of having ≥1 UAI partner with transmission risk vs. 20% for white MSM (CI: 15%, 24%). Despite similarities in other metrics, black MSM in our cohort are three times as likely as white MSM to have HIV transmission risk. With comparable risk behaviors, HIV-negative black MSM have a substantially higher likelihood of encountering a UAI partner at risk of transmitting HIV. Our results support increasing HIV testing, linkage to care, and antiretroviral treatment of HIV-positive MSM to reduce prevalence of those with transmission risk, particularly for black MSM.This publication has 28 references indexed in Scilit:
- Successes and challenges of HIV prevention in men who have sex with menThe Lancet, 2012
- Prevention of HIV-1 Infection with Early Antiretroviral TherapyThe New England Journal of Medicine, 2011
- Estimated HIV Incidence in the United States, 2006–2009PLOS ONE, 2011
- The Spectrum of Engagement in HIV Care and its Relevance to Test-and-Treat Strategies for Prevention of HIV InfectionClinical Infectious Diseases, 2011
- Linkage and Retention in HIV Care among Men Who Have Sex with Men in the United StatesClinical Infectious Diseases, 2011
- Concurrent Partnerships, Acute Infection and HIV Epidemic Dynamics Among Young Adults in ZimbabweAIDS and Behavior, 2010
- Association of highly active antiretroviral therapy coverage, population viral load, and yearly new HIV diagnoses in British Columbia, Canada: a population-based studyThe Lancet, 2010
- Decreases in Community Viral Load Are Accompanied by Reductions in New HIV Infections in San FranciscoPLOS ONE, 2010
- Behavioral interventions to reduce risk for sexual transmission of HIV among men who have sex with menEmergencias, 2008
- Setting the stage: host invasion by HIVNature Reviews Immunology, 2008