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Sexual risk behavior, sexually transmitted infections, and HIV transmission risks in HIV-positive men who have sex with men (MSM) – approaches for medical prevention.

Sexual risk behavior, sexually transmitted infections, and HIV transmission risks in HIV-positive men who have sex with men (MSM) – approaches for medical prevention.
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Esser S, Krotzek J, Dirks H, Scherbaum N, Schadendorf D,


Esser S, Krotzek J, Dirks H, Scherbaum N, Schadendorf D, (click to view)

Esser S, Krotzek J, Dirks H, Scherbaum N, Schadendorf D,

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Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG 2017 03 15() doi 10.1111/ddg.13217

Abstract
BACKGROUND
Rising incidence rates of HIV and STIs (sexually transmitted infections) among MSM (men who have sex with men) in Germany since 2001 call for new approaches in medical prevention. The present study addresses appropriate parameters to identify those HIV-positive MSM who are at high risk for transmitting HIV and STIs.

PATIENTS AND METHODS
Over a two-year period, 223 HIV-positive MSM attending the HIV outpatient clinic at the University Medical Center Essen (Germany) were systematically surveyed with respect to their sexual behavior, substance abuse, and psychological well-being in the preceding year. Data analyzed included laboratory and clinical data from the time of the initial HIV diagnosis until January 2014.

RESULTS
In HIV-positive MSM, a history of substance abuse, promiscuity, younger age, and known STIs was associated with a greater incidence of unprotected sexual intercourse and STIs. Apart from a detectable viral load, additional HIV-specific parameters associated with an increased HIV transmission risk included untreated HIV infection, adherence problems, changes in antiretroviral treatment over the preceding twelve months, known multiresistant HIV infection, and a higher CD 4 nadir. Despite routine quarterly monitoring of viral loads – the result thereof was communicated to patients – only 60 % of individuals assessed their HIV transmission risk correctly.

CONCLUSIONS
In HIV-positive MSM, patient history and routine laboratory tests allow for the establishment of patient profiles that suggest sexual behavior associated with a high risk of HIV and STI transmission, thus offering new approaches for medical prevention.

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