Sexual role and HIV-1 set point viral load among men who have sex with men

[Display omitted] •Set-point viral load is higher in insertive than receptive men who have sex with men.•This difference is limited to men presumed to be infected in longer relationships.•This pattern is predicted by mathematical models and confirmed in empirical analysis. HIV-1 set point viral load...

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Bibliographic Details
Published in:Epidemics 2019-03, Vol.26, p.68-76
Main Authors: Stansfield, Sarah E., Mittler, John E., Gottlieb, Geoffrey S., Murphy, James T., Hamilton, Deven T., Detels, Roger, Wolinsky, Steven M., Jacobson, Lisa P., Margolick, Joseph B., Rinaldo, Charles R., Herbeck, Joshua T., Goodreau, Steven M.
Format: Article
Language:English
Subjects:
Adult
Biomarkers - blood
Cohort Studies
HIV Infections - blood
HIV Infections - epidemiology
HIV Infections - transmission
HIV-1
HIV-1 - metabolism
Homosexuality, Male - statistics & numerical data
Humans
MACS study
Male
Mathematical modeling
Men who have sex with men (MSM)
Middle Aged
Network modeling
Set point viral load
Sexual Behavior - statistics & numerical data
Sexual Partners
Sexual role
Viral Load - statistics & numerical data
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Summary:[Display omitted] •Set-point viral load is higher in insertive than receptive men who have sex with men.•This difference is limited to men presumed to be infected in longer relationships.•This pattern is predicted by mathematical models and confirmed in empirical analysis. HIV-1 set point viral load (SPVL) is a highly variable trait that influences disease progression and transmission risk. Men who are exclusively insertive (EI) during anal intercourse require more sexual contacts to become infected than exclusively receptive (ER) men. Thus, we hypothesize that EIs are more likely to acquire their viruses from highly infectious partners (i.e., with high SPVLs) and to have higher SPVLs than infected ERs. We used a one-generation Bernoulli model, a dynamic network model, and data from the Multicenter AIDS Cohort Study (MACS) to examine whether and under what circumstances MSM differ in SPVL by sexual role. Both models predicted higher SPVLs in EIs than role versatile (RV) or ER men, but only in scenarios where longer-term relationships predominated. ER and RV men displayed similar SPVLs. EI men remained far less likely than ER men to become infected, however. When the MACS data were limited by some estimates of lower sex partner counts (a proxy for longer relationships), EI men had higher SPVLs; these differences were clinically relevant (>0.3 log10 copies/mL) and statistically significant (p 
ISSN:1755-4365
1878-0067
DOI:10.1016/j.epidem.2018.08.006