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New HIV Cases High Among French MSM
 
 
  MedPage Today
Published: September 08, 2010
 
Action Points
 
* Clinicians should be aware that MSM continue to be at very high risk for new HIV infection in many parts of the world.
 
* Clinicians for MSM should work closely with them to prevent acquisition or spread of new HIV infections. Early antiretroviral therapy is increasingly considered in HIV-positive sexually active persons, especially those in known serodiscordant partnerships.
 
HIV appears to be out of control among French men who have sex with men, researchers reported.
 
Data for 2008 revealed that men who have sex with men (MSM) accounted for 48% of all new HIV infections in France, according to Stˇphane Le Vu, PhD, of the French National Institute for Public Health, and colleagues.
 
The incidence rate in that population was 1% -- a rate of 1,006 new infections per 100,000 person-years in 2008 -- and 200 times higher than the rate estimated for French heterosexuals, Le Vu and colleagues reported online inThe Lancet Infectious Diseases.
 
"The HIV epidemic seems to be out of control in the MSM population," the researchers contended.
 
Over the six years from 2003 through 2008, HIV incidence among MSM was "comparatively high and stable," the researchers reported -- although the overall incidence of HIV in France fell by about 3.7% a year.
 
The new findings are no surprise to those involved in combating the HIV pandemic, said Robert Hogg, MD, of the British Columbia Centre for Excellence in HIV/AIDS in Vancouver.
 
"Rates in North America in terms of HIV incidence among MSM have been relatively stable and very high for the last little while," he told MedPage Today, although the reasons for that remain unclear.
 
Most analyses of HIV rates are based on new diagnoses, but the French study added a new wrinkle. Using an enzyme immunoassay, Le VU and colleagues were able to gauge the proportion of recent infections among the new diagnoses.
 
After accounting for under-reporting, Le Vu and colleagues estimated that 42,330 people were newly diagnosed with HIV over the study period and that overall HIV incidence decreased significantly from 8,930 new found infections in 2003 to 6,940 in 2008. The decline was significant at P=0.002.
 
The proportion of recent HIV infections, as determined by the immunoassay, remained stable at about 25% a year, they found.
 
Among those with recent infection during the study period, MSM led the way with 40%, compared with French-national heterosexual women and men (at 28% and 22%, respectively), heterosexual non-French-national women and men (at 16% and 12%), and injection drug users (at 15%), Le Vu's team reported.
 
In 2008, however, 48% of some 6,940 new infections were found among MSM, the researchers wrote, with only 1% of new infections seen in injection drug users.
 
Overall, HIV incidence in 2008 was 17 per 100,000 person-years, they reported, based on rates of:
 
* Nine per 100,000 person-years among heterosexuals
* 1,006 per 100,000 person-years among MSM
* 86 per 100,000 person-years among injection drug users
 
In a comment accompanying the French report in The Lancet, Hogg and colleagues at the BC Centre argued that one way to reduce those rates would be to employ a multifaceted approach including both individual and population-based prevention strategies.
 
As well, they argued, such an approach should take into account the increasing evidence that expanding antiretroviral therapy to all people who meet eligibility criteria would reduce the number of new cases.
 
"It's not treatment or prevention," Hogg told MedPage Today. "It's both."
 
Hogg added that any prevention strategy will also have to account for the way sexual transmission occurs among men who have sex with men. The pattern, he said, is "like a series of random forest fires," which can be difficult to extinguish.
 
That contrasts with injection drug users, where transmission usually occurs within a small circle of people involved in using drugs and prevention efforts can be closely targeted, Hogg said.
 
The study was supported by the French National Institute for Public Health Surveillance and the French National Agency for Research on AIDS and Viral Hepatitis. The authors declared they had no conflicts.
 
Hogg reported financial links with GlaxoSmithKline and Merck Frosst Laboratories.
 
Primary source: The Lancet
Source reference:
Le Vu S, et al "Population-based HIV-1 incidence in France, 2003-08: a modelling analysis" Lancet 2010; DOI:10.1016/S1473-3099(10)70167-5.
 
Additional source: The Lancet
Source reference:
Hogg RS, et al "Reduction of HIV incidence in men who have sex with men" Lancet 2010; DOI:10.1016/S1473-3099(10)70200-0.
 
 
 
 
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