HIV incidence and associated risk factors in men who have sex with men in Mainland China: an updated systematic review and meta-analysis.
BACKGROUND
The national annually reported proportion of men who have sex with men (MSM) among people living with HIV (PLWH) is growing in China. To better inform the public health sector how to improve HIV prevention strategies, it is necessary to understand the current level of HIV incidence and its correlates.


METHODS
Google Scholar, PubMed, Web of Science and three major Chinese electronic publication databases (http://qikan.cqvip.com/, http://g.wanfangdata.com.cn/, http://www.cnki.net/, respectively) were searched for studies reporting HIV incidence. Comprehensive Meta-Analysis (CMA) 2.0 statistical software (Biostat, Inc. Englewood, NJ, USA) was used to calculate the pooled HIV incidence and perform subgroup-analysis to find correlates for HIV seroconversion in Chinese MSM. Random effects modelling was then conducted.


RESULTS
Twenty-five eligible studies were included in this meta-analysis. The calculated pooled HIV incidence was 5.61/100 person years (PY), with an increasing trend over time (3.24/100PY, 5.29/100PY, 5.50/100PY in 2005-2008, 2009-2011, 2012-2014 respectively, ?2 test for trend P = 0.04). Subgroup analyses indicated that age <25 years (rate ratio (RR) = 1.85), junior college education and below (RR = 1.87), having = 2 male sexual partners in past 6 months (RR = 2.50), baseline syphilis infection (RR = 2.99), homosexual orientation (RR = 1.91), preferred bottom/versatile roles in anal sexual intercourse (RR = 2.33), and having unprotected anal intercourse in the past 6 months (RR = 2.16) significantly increased the risk for HIV seroconversion (each P < 0.05). Uncircumcised MSM had a marginal statistically significant higher HIV incidence (RR = 3.35, P = 0.051).


CONCLUSIONS
HIV incidence is still alarmingly high among Chinese MSM. Stronger HIV intervention strategies should be implemented, in particular targeting young, less educated and syphilis-infected MSM.
Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Shenyang, Liaoning, 110001, China.|Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, No.79, Qingchun Road, Hangzhou, Zhejiang, 310003, China.
Wei
W
Zhang
Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Shenyang, Liaoning, 110001, China.|Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, No.79, Qingchun Road, Hangzhou, Zhejiang, 310003, China.
Jun-Jie
JJ
Xu
Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia.
Huachun
H
Zou
Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Shenyang, Liaoning, 110001, China.|Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, No.79, Qingchun Road, Hangzhou, Zhejiang, 310003, China.
Jing
J
Zhang
Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Shenyang, Liaoning, 110001, China.|National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, No.155, Changbai Road, Beijing 102206, China.|Corresponding authors. Email: hongshang100@hotmail.com; wangnbj@163.com.
Ning
N
Wang
Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Shenyang, Liaoning, 110001, China.|Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, No.79, Qingchun Road, Hangzhou, Zhejiang, 310003, China.|Corresponding authors. Email: hongshang100@hotmail.com; wangnbj@163.com.
Hong
H
Shang
HIV intervention; MSM