High HIV-1 incidence, correlates of HIV-1 acquisition, and high viral loads following seroconversion among MSM.
BACKGROUND
HIV-1 incidence estimates and correlates of HIV-1 acquisition in African MSM are largely unknown.


METHODS
Since 2005, HIV-1-uninfected men who reported sex with men and women (MSMW) or sex with men exclusively (MSME) were followed at scheduled visits for collection of behavioural and clinical examination data and plasma for HIV-1 testing. Urethral or rectal secretions were collected from symptomatic men to screen for gonorrhoea. Poisson regression methods were used to estimate adjusted incidence rate ratios to explore associations between risk factors and incident HIV-1 infection. Plasma viral loads (PVLs) were assessed over 2 years following seroconversion.


RESULTS
Overall HIV-1 incidence in 449 men was 8.6 [95% confidence interval (CI) 6.7-11.0] per 100 person-years. Incidence was 5.8 (95% CI 4.2-7.9) per 100 person-years among MSMW, and 35.2 (95% CI 23.8-52.1) per 100 person-years among MSME. Unprotected sex, receptive anal intercourse, exclusive sex with men, group sex, and gonorrhoea in the past 6 months were strongly associated with HIV-1 acquisition, adjusted for confounders. PVL in seroconverters was more than 4 log10 copies/ml at 230 (73.4%) of 313 visits in MSMW and 153 (75.0%) of 204 visits in MSME.


CONCLUSIONS
HIV-1 incidence is very high among MSM in coastal Kenya, and many seroconverters maintain high PVL for up to 2 years after infection. Effective HIV-1 prevention interventions, including treatment as prevention, are urgently needed in this population.
Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute, Kilifi, Kenya. ESanders@kemri-wellcome.org
Eduard J
EJ
Sanders
Haile S
HS
Okuku
Adrian D
AD
Smith
Mary
M
Mwangome
Elizabeth
E
Wahome
Gregory
G
Fegan
Norbert
N
Peshu
Elisabeth M
EM
van der Elst
Matthew A
MA
Price
R Scott
RS
McClelland
Susan M
SM
Graham
D000293:Adolescent; D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data*; D003376:Counseling; D006069:Gonorrhea / Q000453:epidemiology* / Q000517:prevention & control; D006679:HIV Seropositivity / Q000453:epidemiology* / Q000523:psychology / Q000635:transmission; D015497:HIV-1 / Q000302:isolation & purification; D007722:Health Knowledge, Attitudes, Practice; D006558:Herpes Genitalis / Q000453:epidemiology* / Q000517:prevention & control; D018451:Homosexuality, Male; D006801:Humans; D015994:Incidence; D007630:Kenya / Q000453:epidemiology; D008297:Male; D020380:Needs Assessment; D011446:Prospective Studies; D012307:Risk Factors; D012725:Sexual Behavior / Q000523:psychology / Q000706:statistics & numerical data*; D057545:Social Stigma; D019562:Viral Load