Sexually Transmitted Infections Among HIV-Infected Individuals in the District of Columbia and Estimated HIV Transmission Risk: Data From the DC Cohort
Author:
Lucar Jose123, Hart Rachel4, Rayeed Nabil4, Terzian Arpi5, Weintrob Amy12, Siegel Marc1, Parenti David M1, Squires Leah E26, Williams Rush27, Castel Amanda D5, Benator Debra A12, Hays Harlen, Binkley Jeffrey, Hart Rachel, Franklin Dana, Rayeed Nabil, Taylor Rob, Hou Qingjiang, Subramanian Thilakavathy, D’Angelo Lawrence, Rahkmanina Natella, Kharfen Michael, Wood Angela, Kumar Princy, Parenti David, Greenberg Alan, Castel Amanda, Young Heather, Peterson James, Happ Lindsey Powers, Jaurretche Maria, Doshi Saumil, Rana Sohail, Fernandez Ricardo, Hebou Annick, Dieffenbach Carl, Masur Henry, Abbott Stephen, Benator Debra, Ruiz Maria Elena, Elio Rick,
Affiliation:
1. Division of Infectious Diseases, The George Washington University Medical Center, Washington, DC 2. Infectious Diseases Section, Veterans Affairs Medical Center, Washington, DC 3. Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, Mississippi 4. Cerner Corporation, Kansas City, Missouri 5. Milken School of Public Health 6. Department of Psychology, The George Washington University, Washington, DC 7. Columbia Health, Columbia University in the City of New York, New York, New York
Abstract
Abstract
Background
Washington, DC, has one of the highest rates of HIV infection in the United States. Sexual intercourse is the leading mode of HIV transmission, and sexually transmitted infections (STIs) are a risk factor for HIV acquisition and transmission.
Methods
We evaluated the incidence and demographic factors associated with chlamydia, gonorrhea, and syphilis among HIV-infected persons enrolled at 13 DC Cohort sites from 2011 to 2015. Using Poisson regression, we assessed covariates of risk for incident STIs. We also examined HIV viral loads (VLs) at the time of STI diagnosis as a proxy for HIV transmission risk.
Results
Six point seven percent (451/6672) developed an incident STI during a median follow-up of 32.5 months (4% chlamydia, 3% gonorrhea, 2% syphilis); 30% of participants had 2 or more STI episodes. The incidence rate of any STIs was 3.8 cases per 100 person-years (95% confidence interval [CI], 3.5–4.1); age 18–34 years, 10.8 (95% CI, 9.7–12.0); transgender women, 9.9 (95% CI, 6.9–14.0); Hispanics, 9.2 (95% CI, 7.2–11.8); and men who have sex with men (MSM), 7.7 (95% CI, 7.1–8.4). Multivariate Poisson regression showed younger age, Hispanic ethnicity, MSM risk, and higher nadir CD4 counts to be strongly associated with STIs. Among those with an STI, 41.8% had a detectable VL within 1 month of STI diagnosis, and 14.6% had a VL ≥1500 copies/mL.
Conclusions
STIs are highly prevalent among HIV-infected persons receiving care in DC. HIV transmission risk is considerable at the time of STI diagnosis. Interventions toward risk reduction, antiretroviral therapy adherence, and HIV virologic suppression are critical at the time of STI evaluation.
Funder
National Institute of Allergy and Infectious Diseases
Publisher
Oxford University Press (OUP)
Subject
Infectious Diseases,Oncology
Cited by
23 articles.
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