TY - JOUR
T1 - Men who have sex with men, risk behavior, and HIV infection
T2 - Integrative analysis of clinical, epidemiological, and laboratory databases
AU - Levy, Itzchak
AU - Mor, Zohar
AU - Anis, Emilia
AU - Maayan, Shlomo
AU - Leshem, Eyal
AU - Pollack, Shimon
AU - Chowers, Michal
AU - Mor, Orna
AU - Riesenberg, Klaris
AU - Sthoeger, Zev
AU - Ram, Daniela
AU - Grossman, Zehava
PY - 2011/6/1
Y1 - 2011/6/1
N2 - (See the editorial commentary by Mayer and Mimiaga, on pages 1371-1373.)Background.Centralized data collection and analytic tools facilitate tracing HIV transmission trends at the patient-population level with increasing resolution, complementing behavioral studies while avoiding sampling biases. By several measures, the rate of HIV infection among men who have sex with men (MSM) in Israel increased in the past several years more rapidly than was expected. We describe features of the data that connect this increase to behavioral changes. Methods .We retrospectively analyzed data from the national HIV reference laboratory and the national HIV and sexually transmitted infections registries. We examined changes in selected epidemiologic and clinical parameters and in the pattern of drug-resistant virus transmission among MSM in Israel. In particular, virus isolates from 296 MSM (23.8% of all MSM who received a diagnosis) were genotyped, drug-resistance conferring mutations were characterized, and phylogenetic trees were constructed. Results .Compared with earlier years, during 2007-2009 MSM were more often infected with drug-resistant virus before treatment initiation, were coinfected with syphilis, and received a diagnosis during acute retroviral syndrome. Phylogenetic analysis suggested frequent transmission of drug-resistant HIV by drug-treated individuals to >1 partner. Secondary transmission of resistant virus by drug-naive patients is also consistent with the phylogenetic patterns. In addition, non-B HIV subtypes began to appear among MSM. Conclusion s.Together, our findings suggest that the sexual behavior of MSM, both HIV-infected and uninfected, has become riskier, contributing to the number of those seeking early clarification of status, to syphilis comorbidity, and to the spread of drug resistance. These findings call for action by public health planners and community-based organizations aimed at increasing awareness of the risks, bringing a change in attitude and establishing safe sex norms.
AB - (See the editorial commentary by Mayer and Mimiaga, on pages 1371-1373.)Background.Centralized data collection and analytic tools facilitate tracing HIV transmission trends at the patient-population level with increasing resolution, complementing behavioral studies while avoiding sampling biases. By several measures, the rate of HIV infection among men who have sex with men (MSM) in Israel increased in the past several years more rapidly than was expected. We describe features of the data that connect this increase to behavioral changes. Methods .We retrospectively analyzed data from the national HIV reference laboratory and the national HIV and sexually transmitted infections registries. We examined changes in selected epidemiologic and clinical parameters and in the pattern of drug-resistant virus transmission among MSM in Israel. In particular, virus isolates from 296 MSM (23.8% of all MSM who received a diagnosis) were genotyped, drug-resistance conferring mutations were characterized, and phylogenetic trees were constructed. Results .Compared with earlier years, during 2007-2009 MSM were more often infected with drug-resistant virus before treatment initiation, were coinfected with syphilis, and received a diagnosis during acute retroviral syndrome. Phylogenetic analysis suggested frequent transmission of drug-resistant HIV by drug-treated individuals to >1 partner. Secondary transmission of resistant virus by drug-naive patients is also consistent with the phylogenetic patterns. In addition, non-B HIV subtypes began to appear among MSM. Conclusion s.Together, our findings suggest that the sexual behavior of MSM, both HIV-infected and uninfected, has become riskier, contributing to the number of those seeking early clarification of status, to syphilis comorbidity, and to the spread of drug resistance. These findings call for action by public health planners and community-based organizations aimed at increasing awareness of the risks, bringing a change in attitude and establishing safe sex norms.
UR - http://www.scopus.com/inward/record.url?scp=79957502497&partnerID=8YFLogxK
U2 - 10.1093/cid/cir244
DO - 10.1093/cid/cir244
M3 - Article
C2 - 21596678
AN - SCOPUS:79957502497
SN - 1058-4838
VL - 52
SP - 1363
EP - 1370
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 11
ER -