HIV Incidence Among Men Who Have Sex With Men After Diagnosis With Sexually Transmitted Infections

Abstract

Background Men who have sex with men (MSM) are at high risk of acquiring HIV infection following 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 pre-exposure prophylaxis (PrEP). Methods Using matched HIV and STI surveillance data from Washington State from 1/1/2007–6/30/2013, we calculated the incidence of new HIV diagnoses following 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 6/30/2013. Cox proportional hazards regression was used to conduct a global comparison of rates. Results From 1/1/2007–6/30/2013, 6577 HIV-negative MSM were diagnosed with 10,080 bacterial STIs at 8,371 unique time points and followed for 17,419 person-years. 280 (4.3%) men were subsequently diagnosed with HIV infection for an overall incidence of 1.6 per 100 person-years (95%CI=1.4–1.8). The estimated incidence of HIV diagnoses among all MSM in the state was 0.4 per 100 person-years. MSM were at the greatest risk of HIV diagnosis after being diagnosed with 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 MSM diagnosed with rectal gonorrhea and early syphilis were at the greatest risk of being diagnosed with HIV infection post-STI diagnosis. These men should be prioritized for more intensive prevention interventions, including PrEP.

High prevalence of HIV, chlamydia and gonorrhoea among men who have sex with men and transgender women attending trusted community centres in Abuja and Lagos, Nigeria

“…The prevalence rates observed in this study are also considerably higher than the 17.2% prevalence among Nigerian MSM that has been previously reported in the IBBSS [14]. Disproportionately high HIV seroprevalence among MSM has been reported in several other sub-Saharan African countries [2,16,18,19,27,28]. This is suggestive of a significant HIV epidemic in the MSM community at a time when new HIV infections and overall prevalence are declining in the general population [29,30].…”

New Human Immunodeficiency Virus Diagnosis Independently Associated With Rectal Gonorrhea and Chlamydia in Men Who Have Sex With Men

“…In most instances, persons diagnosed with a rectal STI in King County are tested concurrently for HIV infection. (15) As a result, it seems unlikely that most of these infections were present at the time of HIV acquisition. It is possible that rectal STI leads to a prolonged change in the rectal mucosa that increases one's susceptibility to HIV even after treatment.…”

Pre-exposure prophylaxis for MSM and transgender persons in early adopting countries

“…The potential decreased use of condoms by PrEP users perceiving decreased HIV acquisition risk may be associated with increased risk for acquiring bacterial STI, which could potentiate HIV transmission in non-adherent PrEP users, in addition to causing STI-related morbidities [80]. The possibility exists that increasing rates of bacterial STI observed among MSM [81, 82] may be associated with increased PrEP use [83].…”