Epidemiology of HIV among US Air Force Military Personnel, 1996-2011

OBJECTIVE:

The objectives of this study were to describe the epidemiology of HIV in the United States Air Force (USAF) from 1996 through 2011 and to assess whether socio-demographic characteristics and service-related mobility, including military deployments, were associated with HIV infection.

METHODS:

We conducted a retrospective cohort analysis of USAF personnel who were HIV-infected during the study period January 1, 1996 through December 31, 2011 and a matched case-control study. Cases were USAF personnel newly-diagnosed with HIV during the study period. Five randomly-selected HIV-uninfected controls were matched to each case by age, length of service, sex, race, service, component, and HIV test collection date. Socio-demographic and service-related mobility factors and HIV diagnosis were assessed using conditional logistic regression.

RESULTS:

During the study period, the USAF had 541 newly diagnosed HIV-infected cases. HIV incidence rate (per 100,000 person-years) among 473 active duty members was highest in 2007 (16.78), among black/ African-American USAF members (26.60) and those aged 25 to 29 years (10.84). In unadjusted analysis restricted to personnel on active duty, 10 characteristics were identified and considered for final multivariate analysis. Of these single (adjusted odds ratio [aOR], 8.15, 95% confidence interval [CI] 5.71-11.6) or other marital status (aOR 4.60, 95% CI 2.72-7.75), communications/ intelligence (aOR 2.57, 95% CI 1.84-3.60) or healthcare (aOR 2.07, 95% CI 1.28-3.35) occupations, and having no deployment in the past 2 years before diagnosis (aOR 2.02, 95% CI 1.47-2.78) conferred higher odds of HIV infection in adjusted analysis.

CONCLUSION:

The highest risk of HIV infection in the USAF was among young unmarried deployment-naïve males, especially those in higher risk occupation groups. In an era when worldwide military operations have increased, these analyses identified potential areas where targeted HIV prevention efforts may be beneficial in reducing HIV incidence in the USAF military population.

Below:  Incidence rates of new HIV diagnoses (and 95% confidence intervals) among active duty Air Force personnel, 1996–2011

Socio-demographic factors of HIV-infected and matched HIV-uninfected United States Air Force active duty personnel, 1996–2011.

Characteristic	Cases(n = 473)	Controls(n = 2315)	Unadjusted Odds Ratio	95% Confidence Interval	P-Value
Marital status*
Married	94	1297	Referent	-	-
Other	46	142	4.21	(2.78–6.38)	<0.0001
Single, never married	333	873	9.76	(7.20–13.2)	<0.0001
Missing	0	3	-	-	-
Highest education attained					0.0074
Bachelors or higher	59	401	Referent	-	-
Some college or less	412	1890	1.71	(1.23–2.38)	0.0013
Missing	2	24	-	-	-
Occupation* *
Communications/ Intelligence	170	494	2.84	(2.14–3.76)	<0.0001
Engineer/ Mechanic/ Repair	94	757	Referent	-	-
Healthcare	48	170	2.20	(1.47–3.29)	0.0001
Other	146	742	1.57	(1.16–2.14)	0.0036
Pilot/ aircrew	15	152	0.73	(0.41–1.31)	0.2875
Rank
Enlisted	430	1982	1.95	(1.36,2.80)	0.0003
Officer	43	333	Referent	-	-
Home of Record^
Continental US	304	1405	Referent	-	-
Other/ unknown	76	318	0.87	(0.59,1.30)	0.5055
Missing	93	592	-	-	-

*Other marital status included individuals who reported that they were neither married nor single on their personnel records.

**The occupation category, engineer, included non-combat engineer; ‘Other’ occupations included infantry/ combat engineer/ Special Forces/ artillery/ armor/ motor transport/ administration and other categories.^A service member’s residence at the time of entrance to the US military.

Full article at:   http://goo.gl/fdcmcx

By:  Hakre S1, Mydlarz DG2, Dawson P3, Danaher PJ4, Gould PL5, Witkop CT5, Michael NL6, Peel SA7, Scott PT6, Okulicz JF4.

• 1United States Military HIV Research Program, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America.
• 2Preventive and Occupational Medicine Branch, National Guard Bureau, Arlington, Virginia, United States of America.
• 3Biostatistics, The EMMES Corporation, Rockville, Maryland, United States of America.
• 4Infectious Disease Service, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, Texas, United States of America.
• 5Air Force Medical Support Agency, Defense Health Headquarters, Falls Church, Virginia, United States of America.
• 6United States Military HIV Research Program, Walter Reed Army Institute of Research, Bethesda, Maryland, United States of America.
• 7HIV Diagnostics and Reference Laboratory, United States Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America. 

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HIV Testing Patterns for United States Air Force Personnel, 2008-2012

OBJECTIVE:

This study evaluated 3rd generation human immunodeficiency virus (HIV) test patterns and HIV infection rates in the United States Air Force (USAF).

STUDY DESIGN:

Retrospective database study.

METHODS:

HIV enzyme-linked immunoassay (ELISA) and Western blot tests were analysed for all USAF personnel from 2008 to 2012. For new HIV cases, unadjusted and adjusted annual rates were calculated per 100,000 persons.

RESULTS:

In total, 1,608,665 tests were performed in 626,298 individuals, with a reactive ELISA observed in 809 (0.001%) persons. Western blot (n = 1949) results included 378 (19.4%) positive, 1283 (65.8%) negative, and 288 (15.0%) indeterminate (WBi). Unadjusted annual HIV rates were between 16.7 and 20.6 per 100,000 persons during the study period. The overall age-adjusted rate was 14.8 cases per 100,000 persons tested. Blacks/African Americans had the highest risk of HIV (risk ratio 7.9 [95% confidence interval 5.78, 9.95] compared to Whites).

CONCLUSIONS:

WBi results, which can cause delays in determining HIV status, were relatively common with the 3rd generation assay. However, this will be mitigated by a planned transition to a 4th generation assay. Although the overall rate of HIV in the USAF is lower than US civilian adults, HIV prevention efforts targeting young Blacks/African Americans may help to reduce HIV incidence in the USAF.

Purchase full article at: http://goo.gl/bepb56

By:  Kugblenu RK1, Paulin PS2, Tastad KJ2, Okulicz JF3.

• 1United States Air Force School of Aerospace Medicine, Public Health and Preventive Medicine Department, Epidemiology Consult Service, Wright-Patterson AFB, OH, USA; Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA.
• 2United States Air Force School of Aerospace Medicine, Public Health and Preventive Medicine Department, Epidemiology Consult Service, Wright-Patterson AFB, OH, USA.
• 3Infectious Disease Service, San Antonio Military Medical Center, Fort Sam Houston, TX, USA. Electronic address: jason.f.okulicz.mil@mail.mil. 
• Public Health. 2016 Jan 12. pii: S0033-3506(15)00485-0. doi: 10.1016/j.puhe.2015.11.019.

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Herpes Simplex Virus Seroprevalence & Seroconversion among Active Duty US Air Force Members with HIV Infection

BACKGROUND:

Herpes simplex virus (HSV) infection is associated with an increased risk of both HIV transmission and acquisition. We evaluated longitudinal HSV serology and sexually transmitted infections (STIs) among active duty US Air Force (USAF) members with HIV infection.

METHODS:

USAF members diagnosed with HIV between 1996 and 2012 were included and divided into 2 groups: 1996-2004 (n=131) and 2005-2012 (n=266). HSV-1 and -2 serology was evaluated at HIV diagnosis. Longitudinal HSV-1 and -2 serology and ICD-9 codes for HSV and non-HSV STIs were also examined for those with ≥1 year of follow-up.

RESULTS:

Patients were most commonly Caucasian (44.2%) or African American (43.4%) men with a median age of 28 years at HIV diagnosis. HSV-2 seroprevalence at HIV diagnosis decreased from the period of 1996-2004 (48.8%) to 2005-2012 (30.1%). Odds of HSV-2 seropositivity was significantly greater for non-Caucasians and for HIV diagnosis between 1996 and 2004, with a trend observed for those age >30 years at HIV diagnosis. 

A total of 81 (20.4%) patients developed STIs by ICD-9 codes, including 24 (6.1%) new genital herpes diagnoses, during a median follow-up of 4.6 years. HSV-2 seroconversion occurred in 33 of 253 (13.0%) with an incidence rate of 5.07 per 100 person-years.

CONCLUSION:

Although HSV-2 seroprevalence at HIV diagnosis decreased over time, high-risk sexual behaviors were ongoing as evidenced by the high proportion of new STI diagnoses and HSV-2 seroconversions. Continued education to reduce risk behaviors is warranted to prevent acquisition and transmission of STIs in HIV-infected persons.

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By:  Cohen JA1, Sellers A2, Sunil TS2, Matthews PE3, Okulicz JF4.

• 1San Antonio Military Medical Center, Department of Internal Medicine, JBSA Fort Sam Houston, TX, United States.
• 2Institute for Health Disparities Research, University of Texas at San Antonio, San Antonio, TX, United States.
• 3Mike O'Callaghan Federal Medical Center, Infectious Disease Service, Nellis AFB, NV, United States.
• 4San Antonio Military Medical Center, Infectious Disease Service, JBSA Fort Sam Houston, TX, United States. Electronic address: jason.f.okulicz.mil@mail.mil.
• J Clin Virol. 2016 Jan;74:4-7. doi: 10.1016/j.jcv.2015.11.012. Epub 2015 Nov 14.

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Military Sexual Trauma among Recent Veterans: Correlates of Sexual Assault and Sexual Harassment

Military sexual trauma (MST) includes sexual harassment or sexual assault that occurs during military service and is of increasing public health concern. The population prevalence of MST among female and male veterans who served during Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) has not been estimated to our knowledge. The purpose of this study is to assess the population prevalence and identify military correlates of MST, sexual harassment, and sexual assault among OEF/OIF veterans.

MST was assessed in the 2009-2011 National Health Study for a New Generation of U.S. Veterans, a survey of 60,000 veterans who served during the OEF/OIF eras (response rate, 34%, n=20,563). Weighted prevalence estimates and AORs of MST, sexual harassment, and sexual assault among women and men were calculated. Gender-stratified logistic regression models controlled for military and demographic characteristics. Data analyses were conducted in 2013-2014.

Approximately 41% of women and 4% of men reported experiencing MST. Deployed men had lower risk for MST compared with non-deployed men, though no difference was found among women. 

However, veterans reporting combat exposure during deployment had increased risk for MST compared with those without, while controlling for OEF/OIF deployment. 

Among women, Marines and Navy veterans had increased risk for MST compared with Air Force veterans. MST was significantly higher among veterans who reported using Veterans Affairs healthcare services.

These prevalence estimates underscore the importance of public awareness and continued investigation of the public health impact of MST.

Via: http://ht.ly/Sa28i 

By: Barth SK1, Kimerling RE2, Pavao J2, McCutcheon SJ3, Batten SV4, Dursa E5, Peterson MR5, Schneiderman AI5.

• 1Department of Veterans Affairs, Office of Public Health, Post Deployment Health, Epidemiology Program, Washington, District of Columbia. Electronic address: shannon.barth@va.gov.
• 2Department of Veterans Affairs, VHA Mental Health Services and National Center for PTSD, VA Palo Alto Health Care System, Palo Alto, California.
• 3Department of Veterans Affairs, VHA Mental Health Services, Washington, District of Columbia.
• 4Booz Allen Hamilton, Washington, District of Columbia.
• 5Department of Veterans Affairs, Office of Public Health, Post Deployment Health, Epidemiology Program, Washington, District of Columbia.