Repeat HIV-Testing Is Associated with an Increase in Behavioral Risk among Men Who Have Sex with Men

The 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.

We 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.

At 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.

This 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.

Below:  Percentage of high (i.e. ≥5 Menza-score points) HIV behavioral risk scores as modified from [23], by number of HIV tests in repeat testers. The bubble size reflects the denominator used to calculate the percentage of high scores. Linear Reg stands for linear regression, assuming a linear relationship between the y-axis (high risk score) and the x-axis (number of tests). Loess stands for local regression, a smoothing technique that allows one to see a pattern without assuming a particular distribution

Table 1

Comparison demographics and risk behavior at baseline. Reported by individuals with a single HIV test during the study period versus those with repeated HIV tests (those with two or more tests, and the subpopulation with five or more tests)

Risk factor/risk behavior (within 12 months prior to test) and demographics	Single testers a	Repeat testers (2 or more tests) a	P value b	Repeat tester (5 or more tests) a	P value b
N	5402	3202		814
Number of male partners (median, IQR)	5 (3–10)	6 (3–12)	<0.001	6 (4–14)	<0.001
10 or more male partners	1624/5397 (30.1 %)	1120/3197 (35.0 %)	<0.001	319 (39.2 %)	<0.001
Intercourse with females also	594/5389 (11.0 %)	277/3192 (8.7 %)	<0.001	64/813 (7.9 %)	0.007
CIAI with male	3188/5347 (59.6 %)	1974/3170 (62.3 %)	0.016	491/804 (61.1 %)	n.s.
CRAI	2611/5343 (48.9 %)	1664/3167 (52.5 %)	0.001	434/802 (54.1 %)	0.003
CRAI and 5 or more male partners	1544/5342 (28.9 %)	1102/3165 (34.8 %)	<0.001	306/802 (38.2 %)	<0.001
CRAI and 10 or more male partners	892/5342 (16.7 %)	632/3165 (20.0 %)	<0.001	181/802 (22.6 %)	<0.001
CRAI with HIV positive	214/5097 (4.2 %)	121/2947 (4.1 %)	n.s.	19/725 (2.6 %)	0.043
CRAI with PWID	56/5281 (1.1 %)	29/3129 (0.9 %)	n.s.	4/790 (0.5 %)	n.s.
CRAI with sex worker	21/5147 (0.4 %)	9/3052 (0.3 %)	n.s.	1/764 (0.1 %)	n.s.
Worked as sex worker	84/3799 (2.2 %)	45/2004 (2.3 %)	n.s.	8/424 (1.9 %)	n.s.
Syphilis c	101 (1.9 %)	59 (1.8 %)	n.s.	23 (2.8 %)	n.s.
Gonorrhea c	274 (5.1 %)	193 (6.0 %)	n.s.	47 (5.8 %)	n.s.
Chlamydia c	214 (4.0 %)	129 (4.0 %)	n.s.	48 (5.9 %)	0.01
Any STI c	596 (11.0 %)	402 (12.6 %)	0.033	126 (15.5 %)	<0.001
Methamphetamine, not injected	363 (6.7 %)	189 (5.9 %)	n.s.	44 (5.4 %)	n.s.
Non-injection stimulant drug use (i.e. methamphetamine, cocaine, poppers, GHB, ketamine, XTC)	1316 (24.4 %)	765 (23.9 %)	n.s.	176 (21.6 %)	n.s.
IDU	77 (1.4 %)	37 (1.2 %)	n.s.	5 (0.6 %)	n.s.
IDU with shared needles	35/5378 (0.7 %)	7/3180 (0.2 %)	0.006	0	0.021
Demographic data
Age (years; median, IQR)	33 (26–43)	32 (26–42)	0.011	32 (26–41)	n.s.
Male	5402 (100 %)	3202 (100 %)	n.s.	814 (100 %)
Hispanic origin	1434/5249 (27.3 %)	850/3105 (27.4 %)	n.s.	203/785 (25.9 %)	n.s.
Race	–	–	<0.001	–	<0.001
Caucasian	3513/5066 (69.3 %)	2112/3021 (69.9 %)	n.s.	547/783 (69.9 %)	n.s.
African-American	317/5066 (6.3 %)	143/3021 (4.7 %)	0.005	39/783 (5.0 %)	n.s.
Asian	398/5066 (7.9 %)	195/3021 (6.5 %)	0.022	52/783 (6.6 %)	n.s.
Pacific Islander	142/5066 (2.8 %)	53/3021 (1.8 %)	0.004	11/783 (1.4 %)	0.030
Native American	37/5066 (0.7 %)	15/3021 (0.5 %)	n.s.	1/783 (0.1 %)	n.s.
Other	659/5066 (13.0 %)	503/3021 (16.7 %)	<0.001	133/783 (17.0 %)	0.002

CIAI, Condomless insertive anal intercourse; CRAI, Condomless receptive anal intercourse; GHB, Gamma hydroxybutyrate; IDU, Injection drug use; IQR, Inter-quartile range; MSM, Men who have sex with men; n.s., Not significant; PWID, Person who injects drugs; STI, Sexually transmitted infection; XTC, Ecstasy

a Data available from all individuals if denominator not depicted

b Calculated using χ 2 or Mann–Whitney U-test

c All self-reported diagnosis within the last 12 months

Full article at: http://goo.gl/W41EKW

By: Martin Hoenigl, Christy M. Anderson, Nella Green, Sanjay R. Mehta, Davey M. Smith, and Susan J. Little

AntiViral Research Center, Division of Infectious Diseases, Department of Medicine, University of California, San Diego, 200 West Arbor Drive #8208, San Diego, CA 92103 USA

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