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Sexual Health Sexual Health Society
Publishing on sexual health from the widest perspective
RESEARCH ARTICLE

Incidence of putative HIV superinfection and sexual practices among HIV-infected men who have sex with men

Mohsin M. Sidat A , Anne M. Mijch B , Sharon R. Lewin B C , Jennifer F. Hoy B C , Jane Hocking A and Christopher K. Fairley A D E

A School of Population Health, The University of Melbourne, Vic. 3010, Australia.

B Department of Medicine, Monash University, Vic. 3800, Australia.

C Infectious Diseases Unit, The Alfred Hospital, Vic. 3078, Australia.

D Melbourne Sexual Health Centre, 580 Swanston Street, Carlton, Vic. 3053, Australia.

E Corresponding author. Email: cfairley@unimelb.edu.au

Sexual Health 5(1) 61-67 https://doi.org/10.1071/SH07041
Submitted: 19 June 2007  Accepted: 27 November 2007   Published: 22 February 2008

Abstract

Objectives: To determine the upper limit for the incidence of clinically important HIV superinfection among HIV-infected men who have sex with men (MSM) and its relationship with engagement in unsafe sexual practices. Methods: This was a retrospective cohort and nested case-control study. Electronic files of all HIV-infected MSM not on antiretroviral therapy were reviewed. Those clients with sudden, unexplained and sustained declines in CD4 T-cell counts and increases in plasma HIV RNA were considered as being putatively superinfected with HIV and were recruited as cases, whereas those without these features were recruited as controls (four per case) to answer a self-administered questionnaire. Results: Ten cases were identified from 145 eligible MSM (7%, 95% confidence interval 3–11%), comprising a rate of 3.6 per 100 person-years at risk. Cases had an annual decline in CD4 T-cell counts of 201 cells µL–1 compared with 9 cells µL–1 for controls. There were no statistically significant differences between cases and controls with regard to sexual practices that may have exposed them to acquisition of HIV superinfection (P-value ≥ 0.4), nor in their perceptions or beliefs of HIV superinfection (P-value ≥ 0.3). Only a minority reported no previous knowledge of HIV superinfection (17%, 5/30). Overall, both cases and controls were engaging frequently in unsafe sexual practices with casual partners who were HIV infected (80 and 52%, respectively; P-value = 0.4) or whose HIV serostatus was unknown (40 and 50%, respectively; P-value = 1.0). Conclusions: Despite considerable unsafe sexual practices occurring among this cohort of sexually active MSM the incidence of clinically significant HIV superinfection was likely to be less than 4% per year.

Additional keywords: HIV superinfection, men who have sex with men, unsafe sexual practices.


Acknowledgements

The authors would like to express their thanks to all of the staff at the HIV Referral Clinic at Melbourne Sexual Health Centre as well as all of the staff from the HIV Clinic at The Alfred Hospital for assisting in recruiting participants for this study. In particular we would like to thank Kerrie Watson (from the Infectious Diseases Unit, The Alfred Hospital) and Tim Kuo (from the Melbourne Sexual Health Centre) for their valuable assistance at different stages of this study. Many thanks also to all participants who cordially agreed to take part in this study. Lastly, but not least, thank you to The Capacity Building Project (Higher Education) of the University Eduardo Mondlane (Maputo, Mozambique) for providing a scholarship to Mohsin Sidat for his PhD studies at The University of Melbourne (Australia). SRL is an NHMRC practitioner fellow.


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