Characterizing Experiences of Conversion Therapy Among Middle-Aged and Older Men Who Have Sex with Men from the Multicenter AIDS Cohort Study (MACS)

Abstract Objective We evaluated trends and population effectiveness (tolerability, HIV suppression) of current combination antiretroviral therapy (cART) regimens mindful of treatment guidelines. Method Trend analyses included 18 017 person-visits (1457 men) on cART during 2008–2017 in the Multicenter AIDS Cohort Study. Effectiveness analyses of current regimens used 3598 person-visit–pairs (745 men) on cART in 2014–2017. Inverse-probability-of-treatment-and-censoring weighted Poisson regression with robust variances was used to evaluate the association between regimens and switching, adherence and HIV RNA <20 copies/mL. Results Integrase strand transfer inhibitor (INSTI)-based regimen usage has increased since 2008. Almost 90% of cART initiators started with INSTI-cART in 2016–2017; cART adherence was stable around 90% and 83%–85% suppressed virus (<20 cp/mL). Commonly used regimens in 2014–2017 contained disoproxil fumarate/emtricitabine (TDF/FTC) backbone with efavirenz (EFV, n = 1161 person-visits), elvitegravir/cobicistat (EVG/c, n = 551), rilpivirine (RPV, n = 492), darunavir/ritonavir (DRV/r, n = 351), or atazanavir (ATV)/r (n = 333). Others were dolutegravir/abacavir/lamivudine (DTG/ABC/3TC, n = 401) and EVG/c/tenofovir alafenamide/FTC (EVG/c/TAF/FTC, n = 309). Compared to EFV/TDF/FTC users, ATV/r+TDF/FTC users switched more (rate ratio [RR] = 1.80, 95% confidence interval (CI), 1.17–2.76), while those on DTG/ABC/3TC (RR [95% CI] = 0.16 [0.08–0.31]) or EVG/c/TAF/FTC (RR [95% CI] = 0.12 [0.06–0.27]) switched less. The rate of suppressed HIV RNA was 15% (95% CI, 2%–26%) lower among younger EVG/c/TDF/FTC users and 18% (95% CI, 3%–34%) higher in older DRV/r+TDF/FTC users; adherence did not differ by regimen. Conclusions Consistent with guidelines, recent cART initiators started with INSTI-cART, which was associated with less switching early after initiation. Factors beyond those studied here, such as need for salvage therapy, unique personal characteristics, drug interactions, and cost may influence treatment decisions.

Download Full-text

Estimation of absolute fracture risk among middle-aged and older men and women: the EPIC-Norfolk population cohort study

European Journal of Epidemiology ◽

10.1007/s10654-009-9337-8 ◽

2009 ◽

Vol 24 (5) ◽

pp. 259-266 ◽

Cited By ~ 8

Author(s):

Alireza Moayyeri ◽

Stephen Kaptoge ◽

Robert N. Luben ◽

Nicholas J. Wareham ◽

Sheila Bingham ◽

...

Keyword(s):

Cohort Study ◽

Fracture Risk ◽

Older Men ◽

Middle Aged ◽

Men And Women ◽

Population Cohort ◽

Population Cohort Study ◽

Older Men And Women

Download Full-text

Labor Force Participation and Health-Related Quality of Life in HIV-Positive Men Who Have Sex with Men: The Multicenter AIDS Cohort Study

AIDS and Behavior ◽

10.1007/s10461-012-0257-3 ◽

2012 ◽

Vol 16 (8) ◽

pp. 2350-2360 ◽

Cited By ~ 24

Author(s):

Sergio Rueda ◽

Janet Raboud ◽

Michael Plankey ◽

David Ostrow ◽

Cameron Mustard ◽

...

Keyword(s):

Quality Of Life ◽

Cohort Study ◽

Labor Force Participation ◽

Hiv Positive ◽

Multicenter Aids Cohort Study ◽

Health Related Quality ◽

Related Quality ◽

Health Related ◽

Sex With Men

Download Full-text

HIV Testing Among Middle-Aged and Older Men Who Have Sex With Men (MSM): A Blind Spot?

American Journal of Men s Health ◽

10.1177/1557988319863542 ◽

2019 ◽

Vol 13 (4) ◽

pp. 155798831986354 ◽

Cited By ~ 2

Author(s):

Alvaro Francisco Lopes Sousa ◽

Artur Acelino Francisco Luz Nunes Queiroz ◽

Inês Fronteira ◽

Luís Lapão ◽

Isabel Amélia Costa Mendes ◽

...

Keyword(s):

Hiv Testing ◽

Online Survey ◽

Older Men ◽

Blind Spot ◽

Multivariate Logistic Regression Model ◽

Middle Aged ◽

Factors Associated ◽

Hiv Test ◽

Sex With Men ◽

Older Msm

Middle-aged and older men who have sex with men (MSM) are one of the most underestimated populations with regard to HIV/AIDS infection, despite the worldwide trend of increasing prevalence in recent years. This population also has low rates of testing, although rare studies are done exclusively with middle-aged and older MSM assessing the factors associated with this prevalence. Thus, based on data from an exclusive online survey with middle-aged and older MSM who use geolocation-based dating applications, the purpose of the study was to analyze factors associated with not taking the HIV test among middle-aged (50 years old) and older MSM in Brazil. Using a modification of time-location sampling adapted to virtual reality, 412 volunteers were approached in Grindr®, Hornet®, SCRUFF®, and Daddyhunt®. The multivariate logistic regression model was adopted to produce adjusted odds ratios (ORa), considering a significance level at .05. There were factors associated with not taking the test: being in a relationship (ORa: 0.24; 95% CI [0.10, 0.53]); knowing partner through the applications (ORa: 1.84; 95% CI [1.07, 3.15]); not knowing the serological status (ORa: 5.07; 95% CI [1.88, 13.67]); ejaculating outside of anal cavity (ORa: 1.79; 95% CI [1.04, 3.05]); practicing sex without penetration (ORa: 2.30; 95% CI [1.17, 4.50]); not taking the test as a form of prevention (ORa: 2.83; 95% CI [1.05, 7.68]); and rarely using Viagra in sexual intercourse (ORa: 1.91; 95% CI [1.20, 3.65]). There is a blind spot in the prevalence of HIV testing in older MSM because this population is not being covered by services, which compromises the overall response to HIV, the goals set for universal health coverage.

Download Full-text