The Association of Uncontrolled HIV Infection and Other Sexually Transmitted Infections in Metropolitan Atlanta Youth
BACKGROUND:
Half
of the 19 million sexually transmitted infections (STIs) and 26% of HIV
infections annually in the United States occur in youth aged 13-24 years. STIs
are a risk factor for HIV acquisition and transmission, but data are lacking on
HIV treatment as an intervention to reduce STIs.
METHODS:
A
single-centered, retrospective analysis of HIV-infected sexually active
adolescents and young adults from January 2009 to December 2011 was performed
to compare STI incidence among patients with controlled and uncontrolled HIV
and to identify associated risk factors.
RESULTS:
Of 205
enrolled subjects, 59% were male and 92% African American with mean age of 21
years (2.1 SD). Sixty-six percent were horizontally infected, and 19% met the
definition of controlled HIV. Forty-seven percent were men who have sex with
men, 76% reported condom use, 27% prior sexual abuse, 58% drug use and 50%
claimed >5 lifetime sexual partners. Sixty-seven percent contracted a co-STI
for a cumulative incidence rate of 35 STIs per 100 person-years. Subjects with
uncontrolled HIV had a significantly higher STI incidence than did subjects
with controlled infection (42.7 vs. 19.7 per 100 person-years, P < 0.001).
Uncontrolled individuals had more STIs (P = 0.01), sexual partners (P = 0.008)
and horizontal acquisition (P = 0.001). In an adjusted logistic model, having
≥1 STI was associated with older age (P = 0.033), >5 sexual partners (6-10
partners, P = 0.001; >10, P < 0.001) and no condom use (P = 0.025). Subjects
with uncontrolled infection had 2.8 times [95% confidence interval (CI):
1.16-6.94] the odds of ≥1 STI relative to controlled HIV.
CONCLUSIONS:
Uncontrolled
HIV increases the incidence of co-STIs among adolescents and young adults.
Interventions to improve antiretroviral compliance and reduce risk behaviors
are urgently needed.
- 1From the *Department of Pediatrics, Children's Healthcare of Atlanta, Georgia; †Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; ‡Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia; §Division of Pediatric Infectious Diseases, Department of Pediatrics, Emory University School of Medicine & Children's Healthcare of Atlanta, Georgia; and ¶Ponce Family and Youth Clinic, Grady Infectious Diseases Program, Grady Health Systems, Atlanta, Georgia.
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