Sexual Seroadaptation Lessons for Prevention and Sex Research from a Cohort of HIV-Positive Men Who Have Sex with Men 英文参考文献.docVIP

SexualSeroadaptation:LessonsforPreventionandSex ResearchfromaCohortofHIV-PositiveMenWhoHave SexwithMen J.JeffMcConnell1*,LarryBragg1,StephenShiboski2,RobertM.Grant1,3 1Gladstone Institute of Virology and Immunology, San Francisco, California, United States of America, 2Department of Epidemiology and Biostatistics, University of CaliforniaSanFrancisco,SanFrancisco,California,UnitedStatesofAmerica,3DepartmentofMedicine,UniversityofCaliforniaSanFrancisco,SanFrancisco,California, UnitedStatesofAmerica Abstract Background:Surveillancedataonsexuallytransmittedinfections(STIs)andbehavioralcharacteristicsidentifiedinstudiesof the risk of seroconversion are often used as to track sexual behaviors that spread HIV. However, such analyses can be confounded by ‘‘seroadaptation’’—the restriction of unprotected anal intercourse (UAI), especially unprotected insertive UAI,toseroconcordantpartnerships. Methods: We utilized sexual network methodology and repeated-measures statistics to test the hypothesis that seroadaptivestrategiesreducetheriskofHIVtransmissiondespitenumerouspartnershipsandfrequentUAI. PrincipalFindings:InaprospectivecohortstudyofHIVsuperinfectionincluding168HIV-positivemenwhohavesexwith men (MSM), we found extensive seroadaptation. UAI was 15.5 times more likely to occur with a positive partner than a negative one (95% confidence interval [CI], 9.1–26.4). Receptive UAI was 4.3 times more likely in seroconcordant partnershipsthanwithnegativepartners(95%CI,2.8–6.6),butinsertiveUAIwas13.6timesmorelikelywithpositives(95% CI,7.2–25.6).OurestimatessuggestthatseroadaptationreducedHIVtransmissionsby98%. Conclusion:PotentiallyeffectiveHIVpreventionstrategies,suchasseroadaptation,haveevolvedincommunitiesofMSM beforetheyhavebeenrecognizedinresearchordiscussedinthepublichealthforum.Thus,tobeinformative,studiesof HIVriskmustbedesignedtoassessseroadaptivebehaviorsratherthanbelimitedtoindividualcharacteristics,unprotected intercourse,andnumbersofpartners.STIsurveillanceisnotan