Differential Rates in Acute HIV Infection Diagnosis in Men Who Have Sex with Men at a Community-Based Organization in Los Angeles, California

Background:  Over 22% of all HIV infections in the United States are diagnosed in African-American MSM. African-American MSM bear the largest disparity in HIV infection compared to other groups at risk with over six times the rate experienced by White MSM. The objective of this study was to determine if there were disparities in diagnosis of acute HIV infection, and thus early HIV detection, among MSM by race.

Methods: Data were analyzed for all HIV positive diagnoses given to MSM at the L.A. Gay & Lesbian Center between January 2011 and January 2014 (n=618). Acute HIV infections were defined as a negative result for an HIV antibody test paired with a positive result for a HIV nucleic acid amplification test (NAAT). Acute HIV infections were compared to non-acute HIV infections in a multivariate logistic regression by race, age group and education level.

Results:  The proportion of acute HIV diagnoses was 16.3% in White MSM but only 4.6% in African-American MSM. A multivariate logistic regression showed that African-American MSM had 74% lower odds of acute HIV infection diagnosis when compared to White MSM (p=0.04, OR: 0.26; CI: 0.11-0.66), controlling for age group and education level.

Conclusions:  African-American MSM in this study accounted for a significantly lower proportion of acute HIV infections than other racial groups. This study demonstrates that African-American MSM have lower rates of early HIV detection, potentially contributing to increased HIV transmission. NAAT testing should be more actively promoted in the African-American MSM community of Los Angeles as a tool for early HIV detection.