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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

Jones, Jeb PhD, MPH, MS; Hoenigl, Martin MD; Siegler, Aaron J. PhD, MHS; Sullivan, Patrick S. DVM, PhD; Little, Susan MD; Rosenberg, Eli PhD

Sexually Transmitted Diseases: May 2017 - Volume 44 - Issue 5 - p 297–302
doi: 10.1097/OLQ.0000000000000596
Original Studies

Background Risk scores have been developed to identify men at high risk of human immunodeficiency virus (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.

Methods We assessed the predictive ability of 3 published scores to predict 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.

Results The predictive ability of each score was low among all MSM and lower among black men compared to white men. Each score had lower sensitivity to predict seroconversion among black MSM compared to white MSM and low area under the curve values for the receiver operating characteristic curve indicating poor discriminatory ability.

Conclusions Reliance on the currently available risk scores will result in misclassification of high proportions of MSM, especially black MSM, in terms of HIV risk, leading to missed opportunities for HIV prevention services.

Three human immunodeficiency virus risk scores for men who have sex with men were found to have low sensitivity to predict seroconversion among men who have sex with men overall, and lower sensitivity in black compared to white men who have sex with men.

From the *Department of Epidemiology, Emory University, Atlanta, GA; †Division of Infectious Diseases, University of California, San Diego, San Diego, CA; and ‡Division of Pulmonology and Section of Infectious Diseases, Medical University of Graz, Graz, Austria

Acknowledgements: Research reported in this publication was supported by National Institutes of Health awards F31AI122973, R01MH085600, R01AI112723, R01DA038196, R25MH081482, P50DA026306, R24AI106039, R01MH100974, the Emory Center for AIDS Research (P30AI050409) and the UCSD Center for AIDS Research (P30AI036214). Dr. Jones was supported by a George W. Woodruff Fellowship from Emory University. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or Emory University.

Sources of support: National Institutes of Health.

Conflict of interest: None declared.

Correspondence: Jeb Jones, PhD, MPH, MS, Department of Epidemiology, Emory University, 1518 Clifton Road, Atlanta, GA 30322. E-mail:

Received for publication June 14, 2016, and accepted January 19, 2017.

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