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More targeted interventions to diagnose HIV during acute infection are needed, researchers warn
Michael Carter, 2016-04-28 07:10:00
Men who have sex
with men (MSM) diagnosed with HIV in the acute phase of HIV infection have a greater number of recent sexual partners and more condomless sex than MSM diagnosed with chronic HIV infection, according to research published
in the online edition of the Journal of
Infectious Diseases. The study was conducted in Los Angeles. Men with acute
HIV infection reported twice as many recent sexual partners and were also more likely
to report condomless receptive and insertive anal sex than men with
demonstrate the increased behavioral risk among MSM with acute infection,”
comment the researchers.
Viral load, and
therefore potential infectiousness, is especially high in the acute phase of
But an article
published in an earlier edition of the journal concluded that because acute and
early stages of HIV infection are of short duration (three and seven weeks,
respectively), they do not require special interventions to control the HIV epidemic
in most settings.
Researchers in Los
Angeles were unconvinced by this assertion. They therefore designed a study
analysing the sexual risk behaviour of MSM newly diagnosed with HIV between
2011 and 2015 at the LA LGBT Center.
A total of 912 MSM
were newly diagnosed with HIV during the study period. Of these, 145 (16%) had
acute infection (defined as a positive HIV nucleic acid amplification test –
NAAT – but a negative HIV antibody text). The other 767 MSM had non-acute
The newly diagnosed
men provided information on their sexual activity in the three months before
their diagnosis, including total number of sexual partners and anal sex without a
MSM with acute
infection had double the number of sexual partners in the previous 30 days (mean,
4.2; median 2) and three months (mean, 9.9; median 4) before their diagnosis
compared to men with non-acute infection (30 day = mean, 2.4, median, 4; three months = mean, 5.3, median,
2; p < 0.001).
Moreover, in the
three months before diagnosis, unprotected receptive anal sex was more common
among men with acute infection (65%) than men with non-acute infection (56%, p
< 0.05). Men with acute infection were also more likely to report insertive
anal sex without a condom in this three-month period (55 vs 50%).
“In our cohort, we
demonstrate that MSM with acute HIV infection have nearly 2-times as many sex
partners in the past 30-days and 3-months, when viremia is at its highest.
Furthermore, those men were more likely to have condomless receptive and
insertive anal intercourse,” conclude the investigators. “We argue that there
is an urgent need to provide targeted interventions to MSM to diagnose acute
infections, even at a greater cost, in order to reach them early with
interventions and treatment to curb onward HIV transmission.”