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|July 2017||Jones J, Hoenigl M, Siegler AJ, Sullivan PS, Little S, Rosenberg E. Assessing the performance of 3 Human Immunodeficiency Virus incidence risk scores in a cohort of black and white men who have sex with men in the South. Sex Transm Dis. 2017;44(5):297-302. PMCID 5407317.|
HIV risk scores have been developed to identify men at high risk of HIV seroconversion. These scores can be used to more efficiently allocate public health prevention resources, such as pre-exposure prophylaxis. However, the published scores were developed with data sets that comprise predominantly white men who have sex with men (MSM) collected several years prior and recruited from a limited geographic area. Thus, it is unclear how well these scores perform in men of different races or ethnicities or men in different geographic regions. This study focused on evaluation of HIV risk scores in a cohort of MSM in the South of the United States.
We assessed the predictive ability of 3 published scores, including the San Diego Early Test Score (SDET), to predict future HIV seroconversion in a cohort of black and white MSM in Atlanta, GA. Questionnaire data from the baseline study visit were used to derive individual scores for each participant. We assessed the discriminatory ability of each risk score to predict HIV seroconversion over 2 years of follow-up.
A total of 32 seroconversions were detected in the cohort. We found that the predictive ability of each score was low among all MSM and lower among black men compared with white men. Each score had lower sensitivity to predict seroconversion among black MSM compared with white MSM. While the sensitivity of the SDET score, was lower than sensitivity of the other two scores (25% vs 62.5%), specificity of the SDET was significantly higher (84% versus 57% and 41%). Similar to both of the other scores, sensitivity of the SDET differed by race. Sensitivity was 50% (95% CI, 16–84%) over 2 years of follow-up for white MSM and 17% (95% CI, 5–37%) among black MSM. Specificity was slightly higher among black MSM (89%; 95% CI, 84–92%) than among white MSM (80%; 95% CI, 75–85%).
In conclusion, reliance on the currently available risk scores will result in misclassification of high proportions of MSM in the South, especially black MSM, in terms of HIV risk, leading to missed opportunities for HIV prevention services. Reasons include that current HIV risk behavior (used for calculation of scores) may be insufficient to predict future risk behavior and future seroconversion.
Also risk scores may be generally less applicable to the South of the United States, where the HIV epidemic is driven mostly by high (untreated) HIV infection prevalence among African American populations, and less by high-risk behavior, which is the main driver of HIV risk, eg, in California.