AEGiS-14IAC: HIV incidence on the rise among homosexual men in Amsterdam: using a novel approach for detecting recent infections.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

HIV incidence on the rise among homosexual men in Amsterdam: using a novel approach for detecting recent infections.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. TuOrC1144)

Dukers NH, Spaargaren J, Geskus RB, Beijnen J, Coutinho RA, Fennema HS
HIV and STD Research, Municipal Health Service, Amsterdam, The Netherlands

BACKGROUND: Dramatic increases are noted in sexually transmitted diseases (STD) and in HIV-related sexual risk behaviour among homosexual men in the industrialized countries. Are these increases the forecast of a resurging HIV epidemic?

METHODS: HIV incidence from 1991 through 2001 (but not 1993) was examined among homosexual men who participated in voluntary anonymous biannual HIV surveys at a large STD clinic (annually about 17,000 visits) in Amsterdam, The Netherlands. Stored seropositive samples were tested with a less sensitive HIV assay and non-reactive samples were further tested for presence of highly active antiretroviral therapy (HAART). Seropositive men who tested non-reactive on the less sensitive assay and did not use HAART, were classified as recently infected (<170 days). Annual HIV incidence and changes herein were examined.

RESULTS: Among 3090 homosexual participants (median age 34 years), 454 were HIV infected of whom 37 recently. The incidence from 1991 through 2001 was for each year: 2.5, 1.7, unavailable, 0, 0.9, 4.0, 5.4, 1.5, 3.7, 5.2 and 4.3 infections/100 person-years (PY) (p trend=0.04). Strikingly, in young (<34 years) men incidence was 2.5/100PY in 1991-1996 and 3.6/100PY in 1997-2001 (p=0.42), whereas in older men incidence was 1.1/100PY in 1991-1996 and 4.3/100PY in 1997-2001 (p=0.03). Thus, while in previous years, incidence was highest in the young, the age-difference has now switched, as the increase in incidence over time is much stronger in older men. Almost all recently infected men were unaware of their infection. Of the 37 men who were recently infected, 70.3% (n=26) had a concurrent STD (i.e. anogenital infection): these 26 men reported sex with 315 males in the preceding 6 months.

CONCLUSIONS: HIV incidence appears to be rising among homosexual men in Amsterdam. It is imperative to trace persons with recent infection, since they are highly infectious, and thus can play a key role in the spread of HIV.

Keywords: AEGIS, Incidence, Homosexuality, HIV Infections, Antiretroviral Therapy, Highly Active, HIV Seropositivity, Sex Behavior, Sexually Transmitted Diseases, Netherlands, Human, Male, epidemiology

020707
TuOrC1144