Incident Sexually Transmitted Infection as a Biomarker for High-Risk Sexual Behavior After Diagnosis of Acute HIV

Abstract

Background Sexually transmitted infection (STI) diagnosis following diagnosis of acute HIV infection (AHI) indicates ongoing high-risk sexual behavior and possible risk of HIV transmission. We assessed predictors of STI acquisition and the effect of time since care entry on STI incidence in AHI patients in care and receiving consistent risk-reduction messaging. Methods Data on incident gonorrhea, chlamydia, trichomoniasis, primary/secondary syphilis, demographic, and clinical risk factors were abstracted from medical charts for patients diagnosed with AHI and engaged in care. Poisson regression models using generalized estimating equations were fit to estimate incidence rates (IR), incidence rate ratios (IRR), and robust 95% confidence intervals (CI). Results Among 185 AHI patients, 26 (14%) were diagnosed with ≥1 incident STI over 709.4 person-years; 46 STIs were diagnosed during follow-up (IR=6.8/100 person-years). The median time from HIV care entry to first STI diagnosis was 609 days (range=168–1681). Men who have sex with men (MSM) (p=0.03), a shorter time between presentation to medical care and AHI diagnosis (p=0.06), and STI diagnosis prior to AHI diagnosis (p=0.0003) were predictors of incident STI. STI IR >1 year after entering care was double that of patients in care ≤1 year (IRR=2.0 95% CI 0.8–4.9). HIV viral load was above the limits of detection within 1 month of 11 STI diagnoses in 6 patients (23.1%) (median=15,898 copies/mL, range=244–152,000 copies/mL). Conclusions Despite regular HIV care, STI incidence was high among this primarily young, MSM AHI cohort. Early antiretroviral initiation may decrease HIV transmission given ongoing risk behaviors despite risk-reduction messaging.

Examining Sexual Function Among Individuals With HIV in a Midwestern US Urban Outpatient Clinic Setting

“…This finding was contrary to what was expected, and populations with HIV had been documented to engage in higher rates of sexual behaviors with more sex partners than individuals without HIV. 29,30 Yet this does support more recent research, which suggests that populations with HIV are not engaging in higher risk behaviors than the uninfected population, although they are more likely to encounter individuals who are HIV infected, thus resulting in HIV transmission. 31 Further, this finding suggests that populations with HIV may be meeting their sexual needs in a safe manner with masturbation.…”

Short-term outcomes of rapid initiation of antiretroviral therapy among HIV-positive patients: real-world experience from a single-centre retrospective cohort in Taiwan

“…A high rate (6.6 per 100 PYFU) of incident STIs has been found among patients with acute HIV infection7 and patients who continued to practice condomless anal intercourse after being diagnosed as having HIV infection 32. In this study, the incidence of any STI before the achievement of viral suppression was higher in patients without rapid ART initiation than it was in those with rapid ART initiation (28.3 vs 18.8 per 100 PYFU) within a short follow-up duration; this thus raises concerns that STIs may facilitate HIV transmission through genital secretions with relatively high HIV RNA loads 33 34.…”

“…The TEMPRANO and START studies have provided evidence that early initiation of combination antiretroviral therapy (cART) is associated with a more favourable prognosis; subsequently, the WHO recommended in 2015 that all patients be treated with cART once HIV infection is diagnosed 1–5. At the population level, starting antiretroviral therapy (ART) soon after HIV diagnosis can prevent onwards HIV transmission (‘treatment as prevention’),6 especially when high rates of incident sexually transmitted infections (STIs) are observed among patients diagnosed as having acute HIV infection, which are considered biomarkers of onwards transmission 7. In the PARTNER 1 and PARTNER 2 studies, no within-couple HIV transmission occurred through condomless sex between serodiscordant heterosexuals or between male homosexual couples when the HIV-positive partners were on suppressive ART 8 9.…”

Increasing incidence of syphilis among patients engaged in HIV care in Alberta, Canada: a retrospective clinic-based cohort study

“…Syphilis, similar to other STI’s, acts synergistically with HIV, both increasing susceptibility to infection and leading to worse health outcomes [ 4 – 6 ]. Asymptomatic or undiagnosed syphilis negatively impacts HIV prognoses by reducing CD4 counts and increasing viral loads making early syphilis detection important when delivering HIV care [ 5 – 8 ].…”