Drug-Resistant HIV in MSM: Do Sexual Networks Play a Role?

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African-American MSM and transgender individuals may have lower access to care and poorer adherence to therapy than other men, creating pockets of exceptional risk.
African-American MSM and transgender individuals may have lower access to care and poorer adherence to therapy than other men, creating pockets of exceptional risk.

A study conducted at the Los Angeles LGBT Center found that sexual partnership characteristics were associated with drug-resistant HIV in men who have sex with men (MSM). Findings were published in PLoS One.

Using data from the National Institute of Drug Abuse-funded Metromates cohort study, conducted between 2009 and 2012, Pamina M. Gorbach, MHS, DrPH, professor in the department of epidemiology, Fielding School of Public Health at the University of California, Los Angeles, and colleagues analyzed 154 MSM with resistant testing data. Participants completed a questionnaire using a computer-assisted self-interviewing survey that assessed sexual partner type, types of sexual activity, substance use, use of antiretroviral drugs for treatment, and pre- and post-exposure prophylaxis.

Among the 154 MSM recently diagnosed with HIV using plasma samples, the mean age was 30 years, 48% identified as Hispanic, 29% identified as white, and 17% identified as African American.

Of the 154 participants, 19.5% (n=30) had drug resistance to at least 1 class of antiretroviral drugs. Those reporting a transgender partner in the last 12 months (n=30) had a higher prevalence of drug resistance than those who did not (40% vs 17%; P =.04). Similarly, participants who reported having a main partner had a lower prevalence of drug resistance (12% vs 24%; P =.07).

In multivariable analyses adjusting for HIV recency (recent vs chronic infection) and antiretroviral use, reporting a main partner decreased odds of drug resistance, whereas reporting a transgender partner or being African American increased odds of drug resistance:

  • Main partner: adjusted odds ratio (AOR), 0.34; 95% CI, 0.13-0.87
  • Transgender partner: AOR, 3.37; 95% CI, 0.95-12.43
  • African American: AOR, 5.63; 95% CI, 1.41-22.38

Although the sample size for this study was small, with inherent misreporting that can occur in behavioral reports and tools developed in 2008 and earlier that did not have evolved ways of studying transgender individuals, findings from the study suggest that African-American MSM and transgender individuals in Los Angeles are at exceptional risk for drug-resistant HIV.

"Our findings indicate different transmission dynamics are emerging and the role of race/ethnicity and partnering patterns in the epidemic is becoming more apparent," the researchers concluded. Focusing on prevention and care of African-American MSM and transgender individuals to enhance their own health will likely reduce transmission of drug resistance HIV in the United States.

Reference

Gorbach PM, Javanbakht M, Bornfleth L, Bolan RK, Lewis Blum M. Drug resistant HIV: behaviors and characteristics among Los Angeles men who have sex with men with new HIV diagnosis. PLoS One. 2017;12:e0173892. doi: 10.1371/journal.pone.0173892

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