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BMC Medicine

, 13:218

First Online: 07 October 2015Received: 29 June 2015Accepted: 19 August 2015DOI: 10.1186-s12916-015-0458-5

Cite this article as: Hoenigl, M., Anderson, C.M., Green, N. et al. BMC Med 2015 13: 218. doi:10.1186-s12916-015-0458-5


BackgroundThe Center for Disease Control and Prevention recommends that high-risk groups, like sexually active men who have sex with men MSM, receive HIV testing and counseling at least annually. The objective of this study was to investigate the relationship between voluntary repeat HIV testing and sexual risk behavior in MSM receiving rapid serologic and nucleic acid amplification testing.

MethodsWe performed a cohort study to analyze reported risk behavior among MSM receiving the -Early Test-, a community-based, confidential acute and early HIV infection screening program in San Diego, California, between April 2008 and July 2014. The study included 8,935 MSM receiving 17,333 -Early Tests-. A previously published risk behavior score for HIV acquisition in MSM i.e. Menza score was chosen as an outcome to assess associations between risk behaviors and number of repeated tests.

ResultsAt baseline, repeat-testers n = 3,202 reported more male partners and more condomless receptive anal intercourse CRAI when compared to single-testers n = 5,405, all P <0.001. In 2,457 repeat testers there was a strong association observed between repeated HIV tests obtained and increased risk behavior, with number of male partners, CRAI with high risk persons, non-injection stimulant drug use, and sexually transmitted infections all increasing between the first and last test. There was also a linear increase of risk i.e. high Menza scores with number of tests up to the 17th test. In the multivariable mixed effects model, more HIV tests OR = 1.18 for each doubling of the number of tests, P <0.001 and younger age OR = 0.95 per 5-year increase, P = 0.006 had significant associations with high Menza scores.

ConclusionsThis study found that the highest risk individuals for acquiring HIV e.g. candidates for antiretroviral pre-exposure prophylaxis can be identified by their testing patterns. Future studies should delineate causation versus association to improve prevention messages delivered to repeat testers during HIV testing and counseling sessions.

KeywordsAcute and early HIV MSM Risk behavior NAT screening Repeat testing AbbreviationsAEHAcute and early HIV infection

AUCArea under the curve

CIConfidence interval

CRAICondomless receptive anal intercourse

IQRInter-quartile range

MSMMen who have sex with men

n.s.not significant

NATNucleic acid amplification testing

OROdds ratio

PWIDPerson who injects drugs

ROCReceiver operating characteristics

STISexually transmitted infections

Original data of this manuscript have been presented in part at CROI 2015 in Seattle, USA Poster Control IDs 2086188 and 2082732.

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Autor: Martin Hoenigl - Christy M. Anderson - Nella Green - Sanjay R. Mehta - Davey M. Smith - Susan J. Little


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