Repeat HIV-testing is associated with an increase in behavioral risk among men who have sex with men: a cohort study

Abstract

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.

Signs or Symptoms of Acute HIV Infection in a Cohort Undergoing Community-Based Screening

“…This practice may be relatively insensitive in settings where MSM undergo HIV screening frequently ( 11 ). Our results show that expansion of AHI screening to include those with signs or symptoms during the 2 weeks before the test may increase the yield of AHI diagnoses by more than half.…”

“…As part of this confidential HIV testing program, routine, individual donation, HIV nucleic acid amplification testing (NAT) has been provided to all rapid antibody–negative participants since June 2007 (samples for NAT are obtained at the time of rapid antibody testing) ( 7 , 10 , 11 ). AHI was defined as having a negative or indeterminate HIV antibody test result in the presence of detectable HIV-1 RNA, corresponding to Fiebig stages I–II, with a mean estimated date of infection within the previous 10 days (95% CI 7–14 days) ( 12 ).…”

Risk Factors Associated With Repeated HIV Testing Among Internet-Using Men Who Have Sex With Men

“…29,37 In a cohort study of MSM living in San Diego, California, MSM who reported more than 10 male partners and condomless receptive anal intercourse was associated with higher rates of repeat testing. 45 Testing associated with a high-risk sexual behavior such as CAI may lead to justification of that behavior by the individual if the test results are continuously negative, increasing the risk of HIV transmission. 36 This is especially important when considering offering high-risk MSM self-tests such as OraQuick, which has a large window period.…”

Costs per Diagnosis of Acute HIV Infection in Community-based Screening Strategies: A Comparative Analysis of Four Screening Algorithms

“…Participants were MSM who reported sexual contact with men during the 12 months prior to testing. Basic demographics, risk behaviors, and frequency of repeat HIV testing from this cohort have been published previously [20][21][22]. An estimated date of infection was calculated for all recently infected persons using previously published criteria for serologic and virologic test results [23].…”