Molecular Epidemiology of HIV-1 Infection among Men who Have Sex with Men in Taiwan in 2012

The number of men who have sex with men (MSM) infected with HIV-1 in Taiwan has increased rapidly in the past few years. The goal of this study was to conduct a molecular epidemiological study of HIV-1 infection among MSM in Taiwan to identify risk factors for intervention. Voluntary counseling program and anonymous testing were provided to patrons at 1 gay bar, 7 night clubs and 3 gay saunas in Taipei and New Taipei Cities in 2012. HIV-1 subtypes were determined using gag subtype-specific PCR and phylogenetic analysis by env sequences. Recent HIV-1 infection was determined using LAg-Avidity EIA. In-depth interviews and questionnaires were used to identify risk factors. The prevalence and incidence of HIV-1 among MSM in Taiwan were 4.38%(53/1,208) and 3.29 per 100 person-years, respectively. Of 49 cases genotyped, 48 (97.9%) were infected with subtype B and 1 with CRF01_AE (2%). Phylogenetic analysis of 46 HIV-1 strains showed that 25 (54.4%) subtype B strains formed 9 clusters with each other or with other local strains. The CRF01_ AE case clustered with a reference strain from a Thai blood donor with bootstrap value of 99. Multivariate logistic regression analysis showed that risk factors associated with HIV-1 infection included use of oil-based solution as lubricant (vs. saliva or waterbased lubricants, OR=4.23; p < 0.001); exclusively receptive role (vs. insertive role, OR=9.69; p < 0.001); versatile role (vs. insertive role, OR=6.45; p=0.003); oral sex (vs. insertive role, OR=11.93; p=0.044); times of sexual contact per week (2-3 vs. zero per week, OR=3.41; p=0.021); illegal drug use (OR=4.12; p < 0.001); and history of sexually transmitted diseases (OR=3.65; p=0.002). In conclusion, there was no new HIV-1 subtype or circulating recombinant in Taiwan in 2012. Misuse of oil-based solution as lubricant is a new risk factor identified among MSM in Taiwan. The Taiwan's Centers for Disease Control has created a video (www.youtube. com/watch?v= BinExvvOTMM&feature = iv& src_vid=BW81-PfmY3E&annotation_ id = annotation_2436493705) to correct such misconception in its AIDS prevention campaign.