|
|
|
|
|
|
Session 116
Poster Presentations The HIV/STD Interface Session Day and Time: Tuesday 1:30 - 3:30 pm Room: Hall B |
High
HSV-2 prevalence and willingness to participate in Acyclovir Suppression suppression trial among HIV-negativeednegative Peruvian men who have
sex with men (MSM)
Goicochea P, Sanchez
J, Kusunoki L, Whittington W, Lucchetti A, Tapia K, Ashley
R, Galea J, Celum C
Background:
Observational
studies have indicated Aan
association between HSV-2
seropositivity and has
been associated with HIV
acquisition among among heterosexuals
women and
men who have sex with men (MSM) MSM has been described in observational studies.
In Llittle
is known about HSV-2 prevalence among MSM
in Peru, correlates of HSV-2 infection, or the willingness
of MSM to
participate in an upcoming intervention trial to test whether HSV-2 suppression
reduces HIV acquistionacquisition
rates.
We performed
conducted HSV-2
serologic testing and counseling, risk assessment, and determinedation of willingness
to participate in the randomized trial of acyclovir suppression to prevent HIV
acquisition. were recruited in ,. They were tested for HIV, syphilis (RPR confirmed by treponemal-specific assay, TPHA), and HSV-2 (Focus HerpeSelect-2 EIA). HSV-2 seropositive men were counseled
about clinical manifestations, subclinical shedding, and increased risk of HIV acquisition among HSV-2 seropositives,
and asked about willingness to participate in the placebo-controlled acyclovir
suppression trial.
A higher index (IN) ratio for HSV-2 of > 3.0 was used to increase test specificity. Univariate and
multivariate OR for correlates of baseline HSV-2 seropositivity were
calculated, comparing men with HSV-2 IN > 3.0 and < 1.1.
Results:
A total 136 (54%; 95% CI 47, 60) of HIV-negative men were HSV-2 seropositive, 39% HSV-2 negative-, and 19 (7.58%)
low positive.
Compared to the 99 HSV-2- negative men, the 136 HSV-2 seropositive men were older (median 30
yrs vs. 25 yrs;,
OR 1.07, 95% CI 1.0,
1.1p<0.001), more likely to identify as “gay”(homosexual than bisexual or heterosexual (OR 1.75.7;
95% CI 1.02.8,
2.813.2), a or transvestite (OR 4.84.8, 95% CI 1.81.8, 13.0, 13.0), reported a higher number of male partners in the prior 3
mos (median 5 vs 3 male SP, p<0.001), less likely to have both male and female partners
in the past 3 mos (OR 0.4; 95% CI 0.1, 0.9), and more likely to have positive syphilis serologies (OR
10.3, 95% CI 3.5, 29.8). In the multivariate
model, HSV-2 seropositivity
was associated with older age (OR 1.07, 95% CI 1.0, 1.1), more likely to identify as
homosexual than bisexual or heterosexual (OR 5.3; 95% CI 2.1, 13.2), a
transvestite (OR 2.4, 95% CI 0.8, 7.0), (adj OR ),
homosexual identity (adj OR ),
transvestites (adj OR ), and be syphilis seropositiveity (adj OR 8.7, 95% CI 2.4, 32.0 ). Of HSV-2 seropositive men, 50% reported possible past herpes symptoms (prodromal symptoms, perianal
tenderness, penile or genital lesions). Overall, 778%
of HSV-2 seropositive men indicated they were somewhat or very willing to
participate in the acyclovir suppression trial.
Conclusions:
HSV-2 seroprevalence was high (54% with IN > 3.0) among high-risk HIV- negative Peruvian MSM, with higher prevalence among particular
subgroups (particularyparticularly transvestites), and among men with higher
numbers of male partners or syphilis
seropositivity. Even after counseling about HSV-2, only half were able to
recall past herpes symptoms.
Over ¾ of HSV-2 seropositive men indicated a willingness to
participate in a placebo-controlled trial of acyclovir to prevent HIV acquisition.
The main lesion seems
to me to be the “promise” of multivariate analyses without providing the
results of the same. Might suggest that
the model below includes 3 factors [sexual
identity, transvestite, and sex with both men and women] that
are measuring close to the same thing. A simpler model that includes age,
syphilis, and one (perhaps 2 behavior measures???)
seems a better approach—certainly
inclusion of both
sexual identity and
sex with… seems over the edge.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|