title: Continuous increase in HIV-1 incidence after the year 2000 among men who have sex with men in Rome: insights from a 25-year retrospective cohort study.
abstract: To assess trends in HIV-1 incidence and risk factors for seroconversion among men who have sex with men (MSM) resident in Rome, Italy, a retrospective longitudinal cohort study was conducted over 25 years. Incidence rates and trends were modelled using Poisson regression and risk factors were assessed by multivariate Cox models. Of 1,862 HIV-1-negative individuals, 347 seroconverted during follow-up. HIV-1 incidence rates increased from 5.2/100 persons/year (p/y) in 1986 (95% confidence interval (CI): 2.3–11.5) to 9.2/00 p/y in 1992 (95% CI: 6.4–13.0), decreased to 1.3/100 p/y in 2001 and increased until 2009 (11.7/100 p/y; 95% CI: 7.4–18.6). The risk of HIV-1 seroconversion increased during the study period in younger MSM (incidence rate ratio (IRR) = 17.18; 95% CI: 9.74–30.32 in 16–32 year-olds and IRR = 5.09; 95% CI: 2.92–8.87 in 33–41 year-olds) and in those who acquired syphilis (IRR = 7.71; 95% CI: 5.00–11.88). In contrast, the risk of seroconversion decreased among highly educated MSM (IRR = 0.54; 95% CI: 0.35–0.82) and those without Italian citizenship (IRR = 0.45; 95% CI: 0.28–0.71). The HIV epidemic in MSM living in Rome continues to expand. Targeted prevention programmes against sexually transmitted infections to enhance knowledge transfer and behavioural skills are urgently required.
authors.affiliation: STI/HIV Unit, San Gallicano Dermatological Institute, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Giuliani
authors.forename: M F
authors.initials: MF
authors.lastname: Vescio
authors.forename: A
authors.initials: A
authors.lastname: Latini
authors.forename: G
authors.initials: G
authors.lastname: Palamara
authors.forename: F
authors.initials: F
authors.lastname: Pimpinelli
authors.forename: M G
authors.initials: MG
authors.lastname: Dona
authors.forename: F
authors.initials: F
authors.lastname: Stivali
authors.forename: F
authors.initials: F
authors.lastname: Carduccelli
authors.forename: F
authors.initials: F
authors.lastname: Ensoli
authors.forename: A
authors.initials: A
authors.lastname: Di Carlo
authors.forename: G
authors.initials: G
authors.lastname: Rezza
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D005500:Follow-Up Studies; D015658:HIV Infections / Q000453:epidemiology*; D015528:HIV Seroprevalence / Q000639:trends*; D015497:HIV-1; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016012:Poisson Distribution; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012309:Risk-Taking; D012384:Rome / Q000453:epidemiology; D015229:Sexually Transmitted Diseases, Viral / Q000517:prevention & control; D012959:Socioeconomic Factors; D055815:Young Adult