Increased HIV incidence in men who have sex with men despite high levels of ART-induced viral suppression: analysis of an extensively documented epidemic.

<h4>Background</h4>There is interest in expanding ART to prevent HIV transmission, but in the group with the highest levels of ART use, men-who-have-sex-with-men (MSM), numbers of new infections diagnosed each year have not decreased as ARTcoverage has increased for reasons which remain...

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Autores principales:	Andrew N Phillips, Valentina Cambiano, Fumiyo Nakagawa, Alison E Brown, Fiona Lampe, Alison Rodger, Alec Miners, Jonathan Elford, Graham Hart, Anne M Johnson, Jens Lundgren, Valerie C Delpech
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/51fa6b7e27cb4ef78ca8230b2e6e06ae
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spelling	oai:doaj.org-article:51fa6b7e27cb4ef78ca8230b2e6e06ae2021-11-18T07:57:23ZIncreased HIV incidence in men who have sex with men despite high levels of ART-induced viral suppression: analysis of an extensively documented epidemic.1932-620310.1371/journal.pone.0055312https://doaj.org/article/51fa6b7e27cb4ef78ca8230b2e6e06ae2013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23457467/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>There is interest in expanding ART to prevent HIV transmission, but in the group with the highest levels of ART use, men-who-have-sex-with-men (MSM), numbers of new infections diagnosed each year have not decreased as ARTcoverage has increased for reasons which remain unclear.<h4>Methods</h4>We analysed data on the HIV-epidemic in MSM in the UK from a range of sources using an individual-based simulation model. Model runs using parameter sets found to result in good model fit were used to infer changes in HIV-incidence and risk behaviour.<h4>Results</h4>HIV-incidence has increased (estimated mean incidence 0.30/100 person-years 1990-1997, 0.45/100 py 1998-2010), associated with a modest (26%) rise in condomless sex. We also explored counter-factual scenarios: had ART not been introduced, but the rise in condomless sex had still occurred, then incidence 2006-2010 was 68% higher; a policy of ART initiation in all diagnosed with HIV from 2001 resulted in 32% lower incidence; had levels of HIV testing been higher (68% tested/year instead of 25%) incidence was 25% lower; a combination of higher testing and ART at diagnosis resulted in 62% lower incidence; cessation of all condom use in 2000 resulted in a 424% increase in incidence. In 2010, we estimate that undiagnosed men, the majority in primary infection, accounted for 82% of new infections.<h4>Conclusion</h4>A rise in HIV-incidence has occurred in MSM in the UK despite an only modest increase in levels of condomless sex and high coverage of ART. ART has almost certainly exerted a limiting effect on incidence. Much higher rates of HIV testing combined with initiation of ART at diagnosis would be likely to lead to substantial reductions in HIV incidence. Increased condom use should be promoted to avoid the erosion of the benefits of ART and to prevent other serious sexually transmitted infections.Andrew N PhillipsValentina CambianoFumiyo NakagawaAlison E BrownFiona LampeAlison RodgerAlec MinersJonathan ElfordGraham HartAnne M JohnsonJens LundgrenValerie C DelpechPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 2, p e55312 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Andrew N Phillips Valentina Cambiano Fumiyo Nakagawa Alison E Brown Fiona Lampe Alison Rodger Alec Miners Jonathan Elford Graham Hart Anne M Johnson Jens Lundgren Valerie C Delpech Increased HIV incidence in men who have sex with men despite high levels of ART-induced viral suppression: analysis of an extensively documented epidemic.
description	<h4>Background</h4>There is interest in expanding ART to prevent HIV transmission, but in the group with the highest levels of ART use, men-who-have-sex-with-men (MSM), numbers of new infections diagnosed each year have not decreased as ARTcoverage has increased for reasons which remain unclear.<h4>Methods</h4>We analysed data on the HIV-epidemic in MSM in the UK from a range of sources using an individual-based simulation model. Model runs using parameter sets found to result in good model fit were used to infer changes in HIV-incidence and risk behaviour.<h4>Results</h4>HIV-incidence has increased (estimated mean incidence 0.30/100 person-years 1990-1997, 0.45/100 py 1998-2010), associated with a modest (26%) rise in condomless sex. We also explored counter-factual scenarios: had ART not been introduced, but the rise in condomless sex had still occurred, then incidence 2006-2010 was 68% higher; a policy of ART initiation in all diagnosed with HIV from 2001 resulted in 32% lower incidence; had levels of HIV testing been higher (68% tested/year instead of 25%) incidence was 25% lower; a combination of higher testing and ART at diagnosis resulted in 62% lower incidence; cessation of all condom use in 2000 resulted in a 424% increase in incidence. In 2010, we estimate that undiagnosed men, the majority in primary infection, accounted for 82% of new infections.<h4>Conclusion</h4>A rise in HIV-incidence has occurred in MSM in the UK despite an only modest increase in levels of condomless sex and high coverage of ART. ART has almost certainly exerted a limiting effect on incidence. Much higher rates of HIV testing combined with initiation of ART at diagnosis would be likely to lead to substantial reductions in HIV incidence. Increased condom use should be promoted to avoid the erosion of the benefits of ART and to prevent other serious sexually transmitted infections.
format	article
author	Andrew N Phillips Valentina Cambiano Fumiyo Nakagawa Alison E Brown Fiona Lampe Alison Rodger Alec Miners Jonathan Elford Graham Hart Anne M Johnson Jens Lundgren Valerie C Delpech
author_facet	Andrew N Phillips Valentina Cambiano Fumiyo Nakagawa Alison E Brown Fiona Lampe Alison Rodger Alec Miners Jonathan Elford Graham Hart Anne M Johnson Jens Lundgren Valerie C Delpech
author_sort	Andrew N Phillips
title	Increased HIV incidence in men who have sex with men despite high levels of ART-induced viral suppression: analysis of an extensively documented epidemic.
title_short	Increased HIV incidence in men who have sex with men despite high levels of ART-induced viral suppression: analysis of an extensively documented epidemic.
title_full	Increased HIV incidence in men who have sex with men despite high levels of ART-induced viral suppression: analysis of an extensively documented epidemic.
title_fullStr	Increased HIV incidence in men who have sex with men despite high levels of ART-induced viral suppression: analysis of an extensively documented epidemic.
title_full_unstemmed	Increased HIV incidence in men who have sex with men despite high levels of ART-induced viral suppression: analysis of an extensively documented epidemic.
title_sort	increased hiv incidence in men who have sex with men despite high levels of art-induced viral suppression: analysis of an extensively documented epidemic.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/51fa6b7e27cb4ef78ca8230b2e6e06ae
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Increased HIV incidence in men who have sex with men despite high levels of ART-induced viral suppression: analysis of an extensively documented epidemic.

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