title: Men who have sex with men, risk behavior, and HIV infection: integrative analysis of clinical, epidemiological, and laboratory databases.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors: Infectious Disease Unit, Sheba Medical Center, Ramat Gan, Israel.
authors: Itzchak
authors: I
authors: Levy
authors: Zohar
authors: Z
authors: Mor
authors: Emilia
authors: E
authors: Anis
authors: Shlomo
authors: S
authors: Maayan
authors: Eyal
authors: E
authors: Leshem
authors: Shimon
authors: S
authors: Pollack
authors: Michal
authors: M
authors: Chowers
authors: Orna
authors: O
authors: Mor
authors: Klaris
authors: K
authors: Riesenberg
authors: Zev
authors: Z
authors: Sthoeger
authors: Daniela
authors: D
authors: Ram
authors: Zehava
authors: Z
authors: Grossman