Measuring population transmission risk for HIV: an alternative metric of exposure risk in men who have sex with men (MSM) in the US.

<h4>Background</h4>Various metrics for HIV burden and treatment success [e.g. HIV prevalence, community viral load (CVL), population viral load (PVL), percent of HIV-positive persons with undetectable viral load] have important public health limitations for understanding disparities.<...

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Autores principales:	Colleen F Kelley, Eli S Rosenberg, Brandon M O'Hara, Paula M Frew, Travis Sanchez, John L Peterson, Carlos Del Rio, Patrick S Sullivan
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2012
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/642556732fb24a84a0a059d0499d460e
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spelling	oai:doaj.org-article:642556732fb24a84a0a059d0499d460e2021-11-18T08:03:12ZMeasuring population transmission risk for HIV: an alternative metric of exposure risk in men who have sex with men (MSM) in the US.1932-620310.1371/journal.pone.0053284https://doaj.org/article/642556732fb24a84a0a059d0499d460e2012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23285274/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Various metrics for HIV burden and treatment success [e.g. HIV prevalence, community viral load (CVL), population viral load (PVL), percent of HIV-positive persons with undetectable viral load] have important public health limitations for understanding disparities.<h4>Methods and findings</h4>Using data from an ongoing HIV incidence cohort of black and white men who have sex with men (MSM), we propose a new metric to measure the prevalence of those at risk of transmitting HIV and illustrate its value. MSM with plasma VL>400 copies/mL were defined as having 'transmission risk'. We calculated HIV prevalence, CVL, PVL, percent of HIV-positive with undetectable viral loads, and prevalence of plasma VL>400 copies/ml (%VL400) for black and white MSM. We used Monte Carlo simulation incorporating data on sexual mixing by race to estimate exposure of black and white HIV-negative MSM to a partner with transmission risk via unprotected anal intercourse (UAI). Of 709 MSM recruited, 42% (168/399) black and 14% (44/310) white MSM tested HIV-positive (p<.0001). No significant differences were seen in CVL, PVL, or percent of HIV positive with undetectable viral loads. The %VL400 was 25% (98/393) for black vs. 8% (25/310) for white MSM (p<.0001). Black MSM with 2 UAI partners were estimated to have 40% probability (95% CI: 35%, 45%) of having ≥1 UAI partner with transmission risk vs. 20% for white MSM (CI: 15%, 24%).<h4>Discussion</h4>Despite similarities in other metrics, black MSM in our cohort are three times as likely as white MSM to have HIV transmission risk. With comparable risk behaviors, HIV-negative black MSM have a substantially higher likelihood of encountering a UAI partner at risk of transmitting HIV. Our results support increasing HIV testing, linkage to care, and antiretroviral treatment of HIV-positive MSM to reduce prevalence of those with transmission risk, particularly for black MSM.Colleen F KelleyEli S RosenbergBrandon M O'HaraPaula M FrewTravis SanchezJohn L PetersonCarlos Del RioPatrick S SullivanPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 7, Iss 12, p e53284 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Colleen F Kelley Eli S Rosenberg Brandon M O'Hara Paula M Frew Travis Sanchez John L Peterson Carlos Del Rio Patrick S Sullivan Measuring population transmission risk for HIV: an alternative metric of exposure risk in men who have sex with men (MSM) in the US.
description	<h4>Background</h4>Various metrics for HIV burden and treatment success [e.g. HIV prevalence, community viral load (CVL), population viral load (PVL), percent of HIV-positive persons with undetectable viral load] have important public health limitations for understanding disparities.<h4>Methods and findings</h4>Using data from an ongoing HIV incidence cohort of black and white men who have sex with men (MSM), we propose a new metric to measure the prevalence of those at risk of transmitting HIV and illustrate its value. MSM with plasma VL>400 copies/mL were defined as having 'transmission risk'. We calculated HIV prevalence, CVL, PVL, percent of HIV-positive with undetectable viral loads, and prevalence of plasma VL>400 copies/ml (%VL400) for black and white MSM. We used Monte Carlo simulation incorporating data on sexual mixing by race to estimate exposure of black and white HIV-negative MSM to a partner with transmission risk via unprotected anal intercourse (UAI). Of 709 MSM recruited, 42% (168/399) black and 14% (44/310) white MSM tested HIV-positive (p<.0001). No significant differences were seen in CVL, PVL, or percent of HIV positive with undetectable viral loads. The %VL400 was 25% (98/393) for black vs. 8% (25/310) for white MSM (p<.0001). Black MSM with 2 UAI partners were estimated to have 40% probability (95% CI: 35%, 45%) of having ≥1 UAI partner with transmission risk vs. 20% for white MSM (CI: 15%, 24%).<h4>Discussion</h4>Despite similarities in other metrics, black MSM in our cohort are three times as likely as white MSM to have HIV transmission risk. With comparable risk behaviors, HIV-negative black MSM have a substantially higher likelihood of encountering a UAI partner at risk of transmitting HIV. Our results support increasing HIV testing, linkage to care, and antiretroviral treatment of HIV-positive MSM to reduce prevalence of those with transmission risk, particularly for black MSM.
format	article
author	Colleen F Kelley Eli S Rosenberg Brandon M O'Hara Paula M Frew Travis Sanchez John L Peterson Carlos Del Rio Patrick S Sullivan
author_facet	Colleen F Kelley Eli S Rosenberg Brandon M O'Hara Paula M Frew Travis Sanchez John L Peterson Carlos Del Rio Patrick S Sullivan
author_sort	Colleen F Kelley
title	Measuring population transmission risk for HIV: an alternative metric of exposure risk in men who have sex with men (MSM) in the US.
title_short	Measuring population transmission risk for HIV: an alternative metric of exposure risk in men who have sex with men (MSM) in the US.
title_full	Measuring population transmission risk for HIV: an alternative metric of exposure risk in men who have sex with men (MSM) in the US.
title_fullStr	Measuring population transmission risk for HIV: an alternative metric of exposure risk in men who have sex with men (MSM) in the US.
title_full_unstemmed	Measuring population transmission risk for HIV: an alternative metric of exposure risk in men who have sex with men (MSM) in the US.
title_sort	measuring population transmission risk for hiv: an alternative metric of exposure risk in men who have sex with men (msm) in the us.
publisher	Public Library of Science (PLoS)
publishDate	2012
url	https://doaj.org/article/642556732fb24a84a0a059d0499d460e
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Measuring population transmission risk for HIV: an alternative metric of exposure risk in men who have sex with men (MSM) in the US.

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