Incidence of putative HIV superinfection and sexual practices among HIV-infected men who have sex with men.
OBJECTIVE
To determine the upper limit for the incidence of clinically important HIV superinfection among HIV-infected men who have sex with men (MSM) and its relationship with engagement in unsafe sexual practices.


METHODS
This was a retrospective cohort and nested case-control study. Electronic files of all HIV-infected MSM not on antiretroviral therapy were reviewed. Those clients with sudden, unexplained and sustained declines in CD4 T-cell counts and increases in plasma HIV RNA were considered as being putatively superinfected with HIV and were recruited as cases, whereas those without these features were recruited as controls (four per case) to answer a self-administered questionnaire.


RESULTS
Ten cases were identified from 145 eligible MSM (7%, 95% confidence interval 3-11%), comprising a rate of 3.6 per 100 person-years at risk. Cases had an annual decline in CD4 T-cell counts of 201 cells microL(-1) compared with 9 cells microL(-1) for controls. There were no statistically significant differences between cases and controls with regard to sexual practices that may have exposed them to acquisition of HIV superinfection (P-value >or= 0.4), nor in their perceptions or beliefs of HIV superinfection (P-value >or= 0.3). Only a minority reported no previous knowledge of HIV superinfection (17%, 5/30). Overall, both cases and controls were engaging frequently in unsafe sexual practices with casual partners who were HIV infected (80 and 52%, respectively; P-value=0.4) or whose HIV serostatus was unknown (40 and 50%, respectively; P-value=1.0).


CONCLUSIONS
Despite considerable unsafe sexual practices occurring among this cohort of sexually active MSM the incidence of clinically significant HIV superinfection was likely to be less than 4% per year.
Sidat
Mohsin M
MM
School of Population Health, The University of Melbourne, Vic. 3010, Australia.
Mijch
Anne M
AM
Lewin
Sharon R
SR
Hoy
Jennifer F
JF
Hocking
Jane
J
Fairley
Christopher K
CK
D000328:Adult; D015496:CD4-Positive T-Lymphocytes / Q000378:metabolism*; D016022:Case-Control Studies; D015331:Cohort Studies; D016001:Confidence Intervals; D015658:HIV Infections / Q000453:epidemiology / Q000276:immunology* / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D018451:Homosexuality, Male / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012747:Sexual Partners; D015163:Superinfection / Q000453:epidemiology / Q000276:immunology* / Q000523:psychology