Coinfection of STIs with HIV among men who have sex with men MSM in Beijing, China

1
Co-infection of STIs with HIV among men who have
sex with men (MSM) in Beijing, China

• Xiaoyan Zhang
• State Key Laboratory for Infectious Disease
  Prevention and Control
• National Center for AIDS/STD Control and
  Prevention, China CDC

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AGENDA

• Introduction about MSM related research in China
• Study design
• Results
• Demographic characteristics
• Sexual risks
• Prevalence of HIV-1 and other infections
• Prevalent HIV-1 subtypes
• Conclusion

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Introduction

• 2006 Chinese National report
• Morbidity and mortality of STIs including
  HIV/AIDS, syphilis and gonorrhea, increased by
  3.5 and 7.2 ,
• New HIV infections 70,000 cases, gt40 by sexual
  transmission.
• The effect of STIs on HIV-1 transmission are not
  clear
• Syphilis and urethritis were reported to result
  in a decrease of CD4 T cell and an increase of
  HIV-viral load, both of which later improved
  after the STIs treatment.
• A study on an Amsterdam cohort of young HIV
  negative MSM The incidence of syphilis and
  gonorrhoea has increased among young homosexual
  men since 1995, while HIV incidence has remained
  stable.
• MSM are vulnerable to infection by HIV and other
  STIs because of their high risky behaviors.

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From Previous Study

• Our previous study found (Beijing, 2005)
  infection rates of HCV and syphilis among MSM
  significantly increased when co-infected with
  HIV
• HCV 1.5 to 17.7,
• Syphilis 11.2 to 35.29.
• co-infected patients showed lower CD4 and higher
  HIV viral load comparing with HIV mono-infected
  MSM
• The infection rate and effect of other STIs on
  HIV-infection and transmission among MSM in
  Beijing has not been established.

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Study design

• Study subjects (n753) MSM recruited at VCT
  clinic at Chaoyang District CDC in Beijing with
  written informed consent .
• Eligibility criteria
• Age should be 18 years old or older
• Residency should be registered as a Beijing
  resident
• Sexual preference should have a life time
  history of sex with other men.
• Questionnaire (30-minute) to collect the
  information about demographic characteristics as
  well as their engagement in risky behaviors.
• Lab testing
• Screening testing to detect the infection of
  HIV, Syphilis, Ureaplasma Urealyticum (UU),
  Chlamydia Trachomatis (CT ), HCV and Toxoplasma
  gondii.
• HIVMSM CD4 cell count and viral load.
• HIV-1 subtypes analysis

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Demographic characteristics

• Age from 18 to 55 years old (median 25).
• All stayed in Beijing in the past 6 months,
  however, 74.25 had migrated from other
  provinces.
• Education More than half (51) were college
  educated or above35 had attended senior high
  school 14 received a junior high school
  education or below.
• Occupations near 70 were office clerks
  (including small business owners, government
  employees, and college students) 15 were labor
  workers10 were unemployed and 5 were others.

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Marriage status

• Most of them were single (70.5)
• Cohabited with homosexual partners (19.3)
• Married a woman(lt10), but only 4.2 were still
  in the marriage, 3.1 of them were separated from
  their wife , 2.4 had divorced.
• Self-reported sexual behaviors indicated
  that about 41 of MSM had engaged in sex with
  both men and women, which suggested a potential
  risk for HIV-1 transmission between MSM and their
  heterosexual partners

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Sex practices by HIV status
All sexual activities were investigated among MSM
with their male sexual partners
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Co-infections with HIV in MSM in Beijing

• The co-infection rate was much higher in HIV MSM
  compared with those in HIV- MSM.
• HIVMSM were most frequently co-infected with
  syphilis.

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Subtype Analysis
Mainly found in heterosexually and IDUs acquired
HIV people
In the MSM population, HIV-1 has evolved with
diversities, partially because of cross-sexual
HIV transmission.
Mainly found in IDUs HIV people
11

gag
env
pol
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Conclusion

• HIV MSM were more likely to have more male sex
  partners and more unprotected insertive anal sex.
• STIs may be associated with an increased risk of
  HIV infection and transmission. HIVMSM were with
  much higher co-infection rate, and they were most
  frequently co-infected with syphilis.
• There is a potential risk for HIV transmission
  between MSM and their heterosexual partners
  (women).
• The HIV-1 strains prevalent among this MSM
  population have evolved with diversities,
  partially because of cross-sexual interaction
  with other high risky groups for HIV infection.
• The data suggest that the strategy for HIV/AIDS
  prevention and control among MSM should be
  combined with STDs in China. It also underscores
  the importance of continuing efforts to educate
  and inform HIV-infected patients about the
  importance of safe sex.

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Acknowledgement

• Chaoyang District CDC Beijing, China
• Xiaoxi Zhang,
• Chen Wang,
• Wang Hengwei,
• Dongliang Li

• State Key Laboratory for Infectious Disease
  Prevention and Control,
• National Center for AIDS/STD Control and
  Prevention, China CDC
• Yiming Shao
• Xiaoyan Zhang
• Shenwei Li
• Yuhua Ruan