Sunday, December 27, 2015

Incidence & Factors Associated with the Risk of Sexually Transmitted Diseases in HIV-Infected People Seen for Care in Italy

The aims of this study were to identify temporal trends in the incidence of sexually transmitted diseases (STDs) in a cohort of HIV-infected people and to evaluate factors associated with the risk of a new STD diagnosis.

All HIV-infected patients in the Icona Foundation Study cohort enrolled after 1998 were included in this study. STD incidence rates (IRs) were calculated and stratified by calendar period. Predictors of STDs were identified using a Poisson regression model with sandwich estimates for standard errors.

Data for 9168 participants were analysed [median age 37.3 (range 18–81) years; 74% male; 30% men who have sex with men (MSM)]. Over 46 736 person-years of follow-up (PYFU), 996 episodes of STDs were observed [crude IR 21.3/1000 PYFU; 95% confidence interval (CI) 20.0–22.6/1000 PYFU]. In multivariable Poisson regression analysis, MSM [rate ratio (RR) 3.03; 95% CI 2.52–3.64 versus heterosexuals], calendar period (RR 1.67; 95% CI 1.42–1.97 for 2008–2012 versus 1998–2002), HIV RNA > 50 HIV-1 RNA copies/mL (RR 1.44; 95% CI 1.19–1.74 versus HIV RNA ≤ 50 copies/mL) and a current CD4 count < 100 cells/μL (RR 4.66; 95% CI 3.69–5.89; P < 0.001 versus CD4 count > 500 cells/μL) were associated with an increased risk of STDs. In contrast, older age (RR 0.82 per 10 years older; 95% CI 0.77–0.89) and being currently on ART (RR 0.38; 95% CI 0.33–0.45) compared with being ART-naïve or on a treatment interruption were associated with a lower risk of developing STDs.

An increase in the incidence of STDs was observed in more recent years. Interventions to prevent STDs and potential spread of HIV should target the younger population, MSM and people currently not receiving ART.

Table 1

Crude incidence of sexually transmitted diseases (STDs) in the whole population (n = 9168)
Number of eventsPYFUIR (95% CI)
Women2041391214.6 (12.7–16.8)
Men7923282424.1 (22.4–25.8)
 18–30 years181398245.4 (39.0–52.5)
 31–40 years4411842123.9 (21.7–26.2)
 41–50 years2761699216.2 (14.3–18.2)
 51–70 years93702113.2 (10.7–16.2)
 > 70 years532915.1 (4.9–35.4)
HIV transmission route
 Heterosexual2291855715.7 (13.9–17.6)
 MSM5611084351.7 (47.5–56.2)
 IDU87149265.8 (4.6–7.1)
 Other56241023.2 (17.5–30.1)
Period of STDs
 1998–20022721574517.2 (15.2–19.4)
 2003–20072691539917.4 (15.4–19.6)
 2008–20124551559229.1 (26.5–31.9)
CD4 count at STD diagnosis
 > 500 cells/μL4572478918.4 (16.7–20.2)
 351–500 cells/μL2031076518.8 (16.3–21.6)
 101–350 cells/μL247983225.1 (22.0–28.4)
 < 100 cells/μL89135065.9 (52.9–81.1)
HIV RNA at STD diagnosis
 < 50 copies/mL1741628910.6 (9.1–12.3)
 > 50 copies/mL8223044627.0 (25.1–28.9)
Years since HIV diagnosis
 < 10 years8602893229.7 (27.7–31.7)
 11–20 years122149568.1 (6.7–9.7)
 > 20 years1126804.1 (2.0–7.3)
 Missing316818.8 (3.6–52.1)
 Primary79439317.98 (14.2–22.4)
 Secondary2481653115.00 (13.2–17.0)
 College3491285527.15 (24.4–30.1)
 University113261443.23 (35.6–52.0)
 Missing2071034320.01 (17.4–22.9)
 Caucasian9094413220.60 (19.3–22.0)
 Afro-American34136424.93 (17.2–34.8)
 Hispanic4596846.50 (33.9–62.2)
 Asian821736.91 (15.9–72.6)
ART status
 Naïve5341196244.64 (40.9–48.6)
 On ART4003129712.78 (11.5–14.1)
 On treatment interruption62347817.83 (13.6–22.8)
ART, antiretroviral therapy; CI, confidence interval; IDU, injecting drug use; IR, incidence rate; MSM, men who have sex with men; PYFU, person-years of follow-up.

Below:  Incidence rate for any sexually transmitted disease (STD) according to HIV transmission route in different periods of observation. IDU, injecting drug use; MSM, men who have sex with men

Full article at:

1Department of Public Health, Infectious Diseases, Catholic University, Rome, Italy
2Clinic of Infectious Diseases, Univeristy of Modena and Reggio Emilia, Modena, Italy
3Department of Epidemiology, National Institute for Infectious Diseases ‘L. Spallanzani’, Rome, Italy
4Department of Infection and Population Health, Division of Population Health, University College London Medical School, Royal Free Campus, London, UK
5Institute of Infectious Diseases, University of Bari, Bari, Italy
6Institute of Infectious Diseases, University of Brescia, Brescia, Italy
7Clinical Department, National Institute for Infectious Diseases ‘L. Spallanzani’, Rome, Italy
8Clinic of Infectious and Tropical Diseases, Department of Health Sciences, San Paolo University Hospital, Milan, Italy
9Nadir Foundation Onlus, Rome, Italy
Correspondence: Dr Antonella Cingolani, Department of Public Health, Infectious Diseases, Catholic University, L.go A. Gemelli, 8, 00167 Roma, Italy. Tel: +390630157021; fax: +39063054519; e-mail:

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