HPTN 061 trial reports: 6% annual HIV incidence for black MSM in the US

At the 19th International AIDS Conference meeting in Washington DC recently, researchers presented important data from the HIV Prevention Trials Network (HPTN) 061 study (due to publish November 2012) on incidence and social correlates of HIV in black men who have sex with men (MSM).  With a view to investigating the acceptability and feasibility of running a randomized control trial of an prevention package (maybe involving PrEP (pre-exposure prophylaxis)), this study recruited 1,553 black MSM across six US HIV “hotspots” who, over three visits arranged over the year of their participation, were questioned, tested and offered counselling and care (http://www.aidsmap.com/page/2448636/).

The headline datum of the report was the figure of 6% for yearly incidence of HIV in young (18-30) black MSM – which places this particular US population in the same league as the populations of the worst-affected sub-Saharan countries.

Analyses of data from US population-based behavioural surveys and surveillance registries have indicated enormously increased HIV risk among MSM, with particularly high incidence among non-Hispanic blacks in places like New York (http://sti.bmj.com/content/87/Suppl_1/A351.2.full.pdf+html?sid=2d473bd2-195f-4979-8c68-81f97d953cdf).  Such indications are confirmed by the findings of HPTN 061, which set itself the not inconsiderable challenge of recruiting and retaining large numbers of participants for a longitudinal study of this socially disadvantaged group.  Not the least significant finding of the study is the existence within this population of a readiness to engage with health care services in projects of this nature (http://www.hptn.org/web%20documents/HPTN061/061FactSheet12Sep11.pdf).

At 12.4% levels of undiagnosed HIV (at the outset of the study) in US black MSM are much higher than in non-black MSM.  This situation seems, incidentally, to be replicated in the UK (15.8% vv. <6%) (http://sti.bmj.com/content/81/4/345.full.pdf+html?sid=c5b94909-c971-4a86-b320-1610763b5be8). Interestingly, 45% of the HPTN 061 participants had female as well as male partners.

Particularly salient in the report was the association (with multi-variate analysis) of undiagnosed HIV with unemployment (OR 2.4) and low income (OR 3.6 for income <$10,000, and OR 3.3 for income >$10,000 but  <$50,000).  Indeed, the researchers’ focus on behaviour and biological factors was questioned by some audience members, on account of the evident structural and socio-economic factors behind the elevated black MSM risk.

 

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