The Influence Factors Of HIV Infection In A Cohort Of Men Who Have Sex With Men In Nanning City

Section one: The HIV infection rate and its influence factors in a baseline survey among MSM in Nanning cityObjective To investigate the HIV infection status and its influence factors among men who have sex with men (MSM) in Nanning. To determine the relative factors of the willingness of the male circumcision among MSM in Nanning. Methods 302 subjects were enrolled who were eligible for the inclusion criteria by the snowball method. The questionnaires were asked through face to face by the qualified trained investigators, the contents of questionnaire included basic demography, sexual behavior characteristics, Circumcision, sexually transmitted diseases clinic situation, drug abuse, AIDS knowledge, attitudes, etc. HIV, syphilis and HSV-2 were test. Results (1) The average number of male partners among MSM was 3.5. Who having sex with females accounted for 19.5%(59/302).The proportions of condom use each time in the course of sex with male and female were 46.1%(118/256)and 28.8%(17/59), respectively. (2) The positive rate of HIV, syphilis and HSV-2 were 364%(11/302), 8.61%(26/302) and 12.25%(37/302), respectively.(3) 12.3%(37/302)of them had circumcised. 25.7%(68/265) of the uncircumcised MSM were willing to accept circumcision. (4) In multiple regression analysis, census registration and the history of anal sex in the last 6 months were significantly associated with HIV infection(P≤0.05),The foreskin medical examination (OR = 2.63, 95% CI 1.93-3.58), the last six months had sexual relations with women (OR = 0.38,95% CI 0.16-0.91) were significantly associated with the willingness of circumcision(P≤0.05).Conclusions (1) The positive rate of HIV, syphilis and HSV-2 were high in MSM population in Nanning. The HIV/STD can be transmitted to their spouse and sex partners through MSM unprotected sex. (2) Census registration and the history of anal sex in the last 6 months were the influence factors of HIV infection among men who have sex with men (MSM) in Nanning. (3) Redundant prepuce and who had sexual relations with women in the last six months were willing to accept circumcision among MSM in Nanning.Section two: The analysis to the follow-up of the cohort of MSM in NanningObjective To determine the incidence of HIV, Syphilis and HSV-2 and the behavior change for the subjects during the follow-up, and investigate the influence factors of the cohort retention, for providing scientific evidence for the local government to develop and adjust the AIDS prevention strategies among MSM. Methods During the study, subjects were provided counseling, condoms and lubricants, volunteers, outreach services, circumcision, and referral services that are all free of charges. The follow-up visits were conducted in 6th month and 12th month. It included questionnaires and HIV, syphilis and HSV-2 tests. The questionnaire included basic demography, sexual behavior charac terist ics, circumcision, sexually transmitted diseases clinic situation, drug abu se, AIDS knowledge, attitudes, etc. Results (1) Of the 291 participants, the incidence rate was 1.1/100 person-years (95%CI:0～3.3) for HIV during the 12-month follow-up, 6.8/100 person-years (95%CI:2.1～11.5) for syphilis and 5.2/100 person-years (95%CI:1.0～9.3) for HSV-2. (2) The male sex partners were statistically significant among 6 month follow-up with relevant baseline and 12 month follow-up with relevant 6 month follow-up (P≤0.05). (3) Cohort of 53 persons for circumcision, the Circumcision rate was 15% (8/53), and 7 people can follow-up. (4) In the study, comparison of related variables between the group losing follow-up and the group of keeping to follow-up indicate that age, the history of receiving HIV test in the past year, the first partner and experiencing male commercial sex in the last 6 months have statistically significance(P≤0.05). (5) The main reason of withdrawal was persons in the cohort promised follow–up via phone calling but still failure in coming back, and phone numbers changed or stopped. In multiple regression analysis, follow-up in 6 month, reside time and female sex in the past 6 month were significantly associated with 12 month follow-up. Conclusions (1) Comparing with other cities in China, the incidence rate of HIV among MSM was low. (2) High-risk behaviors , especially the male sex partner had changed among the MSM cohort .The rate of condom use increased when had sex with male, but change little when had sex with female. (3) The retention rate was low. Follow-up in 6 month, reside time in Nanning and female sex in the past 6 month were significantly associated with 12 month follow-up in the study.Section three: The study of biological factors among MSM HIV infections in NanningObjective To test the HIV viral load, CD4+ lymphocyte count, HIV genotype and TRL9 and IFN-αexpression among the HIV infectors that discovered during the study, providing the biological data for MSM AIDS control. Methods HIV viral load was used the bioMérieux viral load way (NucliSens EasyQ HIV-1) to detect. CD4+ lymphocyte count by flow cytometry was used BD FACSCalibur. TLR9 and IFN-a was used fluorescence transcriptase cDNA quantitative polymerase chain reaction (PCR) to determinate. HIV-1 subtype was used ABI3730 sequencer to sequence. Results (1) 12 HIV infection MSM received CD4+ lymphocyte count test, including 7 people of 200cells/ul -350cells/ul and 5 people of≥350cells/ul. 17 HIV infection MSM participated in viral load test, including 4 people of 500 cp/ml-3000 cp/ml, 2 people of 3000cp/ml-10000cp/ml, 3 people of 10000 cp/ml-30000cp/ml and more than 8 people of over 30000cp/ml. CD4+lymphocyte count and viral load had no correlation(P>0.05). (2) TLR-9 CT in healthy male students and MSM HIV infected group were 30.3±1.3, 28.1±1.1, respectively. There are no significant difference between the two groups (P>0.05). IFN-αCT in healthy male students and MSM HIV infected group were 32.4±1.2, 30.3±1.3, respectively. There was no significant difference between the two groups (P>0.05). (3) In the 14 blood samples of HIV infected MSM, HIV-1gag full-length gene amplified from blood samples of 10, these 10 blood samples were sequenced. After a phylogenetic tree can be seen, subtype CRF01—AE is 9, accounting for 90%, subtype CRF07—BC is 1, accounting for 10%. Conclusions (1) In the HIV infected MSM, CD4+lymphocyte count was low and HIV viral load higher, HIV infection MSM Shorten the incubation AIDS period. (2) TRL9 and IFN-αexpression were low in HIV infection MSM. (3) Subtype CRF01—AE is the main HIV-1 subtype among MSM in Nanning .