Sexually Transmitted Infections Among HIV-Infected Individuals in the District of Columbia and Estimated HIV Transmission Risk: Data From the DC Cohort

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.

[1]  J. Gallant,et al.  Antiretroviral Therapy for the Prevention of HIV-1 Transmission. , 2016, The New England journal of medicine.

[2]  Pietro Vernazza,et al.  Sexual Activity Without Condoms and Risk of HIV Transmission in Serodifferent Couples When the HIV-Positive Partner Is Using Suppressive Antiretroviral Therapy. , 2016, JAMA.

[3]  H. Masur,et al.  Disparities in achieving and sustaining viral suppression among a large cohort of HIV-infected persons in care – Washington, DC* , 2016, AIDS care.

[4]  Rachel Hart,et al.  Development of a large urban longitudinal HIV clinical cohort using a web-based platform to merge electronically and manually abstracted data from disparate medical record systems: technical challenges and innovative solutions , 2016, J. Am. Medical Informatics Assoc..

[5]  Christoph U. Lehmann,et al.  Brief Report: Gonorrhea and Chlamydia Testing Increasing but Still Lagging in HIV Clinics in the United States , 2015, Journal of acquired immune deficiency syndromes.

[6]  Meg Sullivan,et al.  Time above 1500 copies: a viral load measure for assessing transmission risk of HIV-positive patients in care , 2015, AIDS.

[7]  L. Sawers,et al.  Rush to judgment: the STI-treatment trials and HIV in sub-Saharan Africa , 2015, Journal of the International AIDS Society.

[8]  Arielle Lasry,et al.  Estimating per-act HIV transmission risk: a systematic review , 2014, AIDS.

[9]  D. Glidden,et al.  Syphilis Predicts HIV Incidence Among Men and Transgender Women Who Have Sex With Men in a Preexposure Prophylaxis Trial , 2014, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[10]  N. Crum‐Cianflone,et al.  Prevalence and factors associated with asymptomatic gonococcal and chlamydial infection among US Navy and Marine Corps men infected with the HIV: a cohort study , 2013, BMJ Open.

[11]  K. Mayer,et al.  Highly active antiretroviral therapy does not completely suppress HIV in semen of sexually active HIV-infected men who have sex with men , 2012, AIDS.

[12]  M. Cohen,et al.  Classical sexually transmitted diseases drive the spread of HIV-1: back to the future. , 2012, The Journal of infectious diseases.

[13]  B. Agan,et al.  Results of a 25-Year Longitudinal Analysis of the Serologic Incidence of Syphilis in a Cohort of HIV-Infected Patients With Unrestricted Access to Care , 2012, Sexually transmitted diseases.

[14]  J. Mullins,et al.  Genital HIV-1 RNA Predicts Risk of Heterosexual HIV-1 Transmission , 2011, Science Translational Medicine.

[15]  G. Rutherford,et al.  Population-based biomedical sexually transmitted infection control interventions for reducing HIV infection. , 2011, The Cochrane database of systematic reviews.

[16]  Jennifer A. Pellowski,et al.  Prevalence of sexually transmitted co-infections in people living with HIV/AIDS: systematic review with implications for using HIV treatments for prevention , 2011, Sexually Transmitted Infections.

[17]  C. Kent,et al.  STD Screening of HIV-Infected MSM in HIV Clinics , 2010, Sexually transmitted diseases.

[18]  S. Kalichman,et al.  Sexually transmitted infections and infectiousness beliefs among people living with HIV/AIDS: implications for HIV treatment as prevention , 2010, HIV medicine.

[19]  M. Zwahlen,et al.  Occurrence, risk factors, diagnosis and treatment of syphilis in the prospective observational Swiss HIV Cohort Study , 2010, AIDS.

[20]  D. Klein,et al.  Syphilis Epidemiology and Clinical Outcomes in HIV-Infected and HIV-Uninfected Patients in Kaiser Permanente Northern California , 2010, Sexually transmitted diseases.

[21]  Matthias Egger,et al.  Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis , 2009, AIDS.

[22]  R. Lewis,et al.  Asymptomatic sexually transmitted infections in HIV-infected men who have sex with men: prevalence, incidence, predictors, and screening strategies. , 2008, AIDS patient care and STDs.

[23]  R. Bollinger,et al.  High rates of syphilis among STI patients are contributing to the spread of HIV-1 in India , 2006, Sexually Transmitted Infections.

[24]  R. Geskus,et al.  Homosexual men change to risky sex when perceiving less threat of HIV/AIDS since availability of highly active antiretroviral therapy: a longitudinal study , 2004, AIDS.

[25]  E. Erbelding,et al.  New Sexually Transmitted Diseases in HIV‐Infected Patients: Markers for Ongoing HIV Transmission Behavior , 2003, Journal of acquired immune deficiency syndromes.

[26]  J. Chmiel,et al.  Attitudes towards highly active antiretroviral therapy are associated with sexual risk taking among HIV-infected and uninfected homosexual men , 2002, AIDS.

[27]  Steven Gibson,et al.  Impact of highly active antiretroviral treatment on HIV seroincidence among men who have sex with men: San Francisco. , 2002, American journal of public health.

[28]  T. Quinn,et al.  Viral load and heterosexual transmission of human immunodeficiency virus type 1. Rakai Project Study Group. , 2000, The New England journal of medicine.

[29]  B. Leynaert,et al.  Heterosexual transmission of human immunodeficiency virus: variability of infectivity throughout the course of infection. European Study Group on Heterosexual Transmission of HIV. , 1998, American journal of epidemiology.

[30]  J. Todd,et al.  Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomised controlled trial , 1995, The Lancet.

[31]  S. Gichuhi Partners In Prevention Hsv/hiv Transmission Study Team , 2010 .