HIV Incidence among Men Who Have Sex with Men After Diagnosis with Sexually Transmitted Infections
BACKGROUND:
Men
who have sex with men (MSM) are at high risk for acquiring HIV infection after
diagnosis with other sexually transmitted infections (STIs). Identifying the
STIs associated with the greatest risk of subsequent HIV infection could help
target prevention interventions, particularly preexposure prophylaxis (PrEP).
METHODS:
Using
matched HIV and STI surveillance data from Washington State from January 1,
2007, to June 30, 2013, we calculated the incidence of new HIV diagnoses after
different STI diagnoses among MSM. Men entered observation at the time of their
first STI diagnosis during the study period and exited at HIV diagnosis or June
30, 2013. Cox proportional hazards regression was used to conduct a global
comparison of rates.
RESULTS:
From
January 1, 2007, to June 30, 2013, 6577 HIV-negative MSM were diagnosed as
having 10,080 bacterial STIs at 8371 unique time points and followed for 17,419
person-years. Two hundred eighty (4.3%) men were subsequently diagnosed as
having HIV infection for an overall incidence of 1.6 per 100 person-years (95%
confidence interval, 1.4-1.8). The estimated incidence of HIV diagnoses among
all MSM in the state was 0.4 per 100 person-years. Men who have sex with men
were at the greatest risk for HIV diagnosis after being diagnosed as having
rectal gonorrhea (HIV incidence, 4.1 per 100 person-years), followed by early
syphilis (2.8), urethral gonorrhea (1.6), rectal chlamydial infection (1.6),
pharyngeal gonorrhea (1.1), late syphilis (1.0), and urethral chlamydial
infection (0.6; P < 0.0001 overall).
CONCLUSIONS:
Men
who have sex with men diagnosed as having rectal gonorrhea and early syphilis
were at the greatest risk for being diagnosed as having HIV infection after STI
diagnosis. These men should be prioritized for more intensive prevention
interventions, including PrEP.
Below: Cumulative hazard of HIV diagnosis following bacterial STIs (STI) GC = gonorrhea. CT = chlamydial infection
Below: Percent of 736 MSM newly diagnosed as having HIV infection from July 2011 to June 2013 with a reported STI diagnosis in the 2 years before HIV diagnosis GC indicates gonorrhea; CT, chlamydial infection.
Full article at: http://goo.gl/N3Kb5L
- 1From the Departments of *Medicine and †Epidemiology, University of Washington, Seattle, WA; ‡HIV/STD Program, Public Health-Seattle & King County, Seattle, WA; and §Infectious Disease Assessment Unit, Washington State Department of Health, Olympia, WA.
- Sex Transm Dis. 2016 Apr;43(4):249-54. doi: 10.1097/OLQ.0000000000000423.
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