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To assess trends in HIV-1 incidence and risk factors for seroconversion among men who have sex with men (MSM) resident in Rome, Italy, a retrospective longitudinal cohort study was conducted over 25 years. Incidence rates and trends were modelled using Poisson regression and risk factors were assessed by multivariate Cox models. Of 1,862 HIV-1-negative individuals, 347 seroconverted during follow-up. HIV-1 incidence rates increased from 5.2/100 persons/year (p/y) in 1986 (95% confidence interval (CI): 2.3-11.5) to 9.2/00 p/y in 1992 (95% CI: 6.4-13.0), decreased to 1.3/100 p/y in 2001 and increased until 2009 (11.7/100 p/y; 95% CI: 7.4-18.6). The risk of HIV-1 seroconversion increased during the study period in younger MSM (incidence rate ratio (IRR)?=?17.18; 95% CI: 9.74-30.32 in 16-32 year-olds and IRR?=?5.09; 95% CI: 2.92-8.87 in 33-41 year-olds) and in those who acquired syphilis (IRR?=?7.71; 95% CI: 5.00-11.88). In contrast, the risk of seroconversion decreased among highly educated MSM (IRR?=?0.54; 95% CI: 0.35-0.82) and those without Italian citizenship (IRR?=?0.45; 95% CI: 0.28-0.71). The HIV epidemic in MSM living in Rome continues to expand. Targeted prevention programmes against sexually transmitted infections to enhance knowledge transfer and behavioural skills are urgently required. .


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