Sexually transmitted infections in persons living with HIV infection and estimated HIV transmission risk: trends over time from the DC Cohort

Secco, Alessandra; Akselrod, Hana; Czeresnia, Jonathan Mamber; Levy, Matthew E.; Byrne, Morgan; Monroe, Anne; Lucar, Jose; Horberg, Michael A.; Castel, Amanda D.; Doshi, Rupali; Rivasplata, Heather; Squires, Leah; Parenti, David M.; Benator, Debra

doi:10.1136/sextrans-2019-054216

Cited by 17 publications

(17 citation statements)

References 11 publications

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“…A history of STIs was the second factor most strongly associated with monoinfection or coinfection, with a prevalence of reported cases of syphilis and gonorrhea, respectively. Recent studies have shown that the highest risk for STIs is observed in young MSM from the most vulnerable socioeconomic groups 50 , 62 ; among these, those diagnosed with syphilis and gonorrhea have the highest rate of HIV coinfection 102 , similar to our findings. These data are particularly worrying for Brazil because the incidence rates of acquired syphilis have been increasing since 2010 103 , and there is an estimated global increase in cases of gonorrhea, especially in MSM in developing countries 104 .…”

Section: Discussionsupporting

confidence: 90%

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Epidemiological risk factors associated with primary infection by Epstein–Barr virus in HIV-1-positive subjects in the Brazilian Amazon region

Pereira

França

Costa

et al. 2021

Sci Rep

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To identify the prevalence and risk factors for primary Epstein–Barr virus (EBV) infection in human immunodeficiency virus (HIV)-1-positive adult treatment-naïve patients between January 2018 and December 2019 in a state of the Brazilian Amazon region. A total of 268 HIV-1 positive patients and 65 blood donors participated in the study. Epidemiological data were obtained from medical records and through a designed questionnaire. EBV infection was screened by the semiquantitative detection of anti-viral capsid antigen (VCA) EBV IgM and IgG, followed by molecular detection of the EBNA-3C gene. The plasma viral loads of HIV-1 and EBV were quantified using a commercial kit. The prevalence of primary coinfection was 7.12%. The associated risk factors were education level, family income, history of illicit drug use and sexually transmitted infections, homosexual contact and condom nonuse. Approximately 58.5% had late initiation of highly active antiretroviral therapy, which influenced the risk of HIV-EBV 1/2 multiple infection (odds ratio (OR): 4.76; 95% CI 1.51–15.04) and symptom development (p = 0.004). HIV viral load was associated with patient age (OR: 2.04; 95% CI 2.01–2.07; p = 0.026) and duration of illicit drug use (OR: 1.57; 95% CI 1.12–2.22; p = 0.0548). EBV viral load was associated with younger age (OR: 0.82; 95% CI 0.79–1.03; p = 0.0579). The replication of both viruses was associated with symptom development (HIV = OR: 2.06; 95% CI 1.22–3.50; p = 0.0073; EBV = OR: 8.81; 95% CI 1–10; p = 0.0447). The prevalence of HIV/EBV coinfection was lower than that observed in other studies, and social vulnerability and promiscuous sexual behavior were associated risk factors. A long time of HIV-1 infection, without therapy, influenced the risk of coinfection and disease progression. The viral loads of both viruses may be associated with some epidemiological aspects of the population.

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Section: Discussionsupporting

confidence: 90%

“…Although the number of new HIV cases identified is stable nationally, especially in the northern region of the country 47 , 48 , our data warn of an increase in coinfections in PLHIV, a predisposition observed in Brazil 49 and internationally 50 , especially among young men.…”

Section: Discussionmentioning

confidence: 62%

Epidemiological risk factors associated with primary infection by Epstein–Barr virus in HIV-1-positive subjects in the Brazilian Amazon region

Pereira

França

Costa

et al. 2021

Sci Rep

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“…Almost 70% of GC infections were at rectal, pharyngeal, or concurrent rectal and pharyngeal sites, and >50% of CT infections were at the rectal site only. Consistent with prior studies, younger PWH experienced greater rates of GC/CT at each anatomic site, while TW/MSM experienced greater rates of extragenital GC/CT [ 3 , 5 , 6 , 33 ]. Black PWH were more likely to experience urogenital CT infections compared with White PWH.…”

Section: Discussionsupporting

confidence: 85%

Anatomic Site–Specific Gonorrhea and Chlamydia Testing and Incidence Among People With HIV Engaged in Care at 4 US Clinical Centers, 2014–2018

Menza

Berry²,

Dombrowski

et al. 2022

Open Forum Infectious Diseases

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Background The incidence of Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) is increasing in the United States; however, there are limited data on anatomic site-specific GC/CT among people with HIV (PWH). Methods We reviewed records of all PWH in care between January 1, 2014 and November 16, 2018 at four sites in the CFAR Network of Integrated Clinical Systems Cohort (CNICS; N = 8455). We calculated anatomic site-specific GC/CT testing and incidence rates and used Cox proportional hazards models modified for recurrent events to examine sociodemographic and clinical predictors of GC/CT testing and incidence at urogenital, rectal, and pharyngeal sites. We also calculated site-specific number needed to test (NNT) to detect a positive GC/CT test. Results Of 8455 PWH, 2460 (29.1%) had at least yearly GC/CT testing at any anatomic site. The rates of urogenital, rectal, and pharyngeal GC were 1.7 (95%CI:1.6, 1.9), 3.2 (95%CI:3.0, 3.5), and 2.7 (95%CI:2.5, 2.9) infections per 100 person-years, respectively. The rates of urogenital, rectal, and pharyngeal CT were 1.9 (95%CI:1.7, 2.1), 4.3 (95%CI:4.0, 4.5), and 0.9 (95%CI:0.8, 1.0) infections per 100 person-years, respectively. PWH 16-39 years old experienced greater GC/CT rates at all anatomic sites while MSM experienced greater rates of extragenital infections. NNTs for urogenital, rectal, and pharyngeal GC/CT were 20 (95%CI:19, 21), 5 (95%CI:5, 5), and 9 (95%CI:8, 9), respectively. Conclusion Many PWH are not tested annually for GC/CT and rates of GC/CT infection, particularly rates of extragenital infections, are high. We identified groups of PWH who may benefit from increased site-specific GC/CT testing.

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“…To achieve the new goals of “DC Ends HIV” in the District of Columbia, enhanced and timely prevention, rapid testing, and partner treatment for HIV and STIs are necessary [ 8 ]. Previously, we described significant yearly increases in STI incidence rates observed across all adult age groups in the DC Cohort [ 12 , 23 ]. Identifying geographically specific information regarding STIs and potential for HIV transmission allows for expansion of resources on treatment and prevention of HIV, including outreach for U = U, PrEP, and STI prevention campaigns.…”

Section: Discussionmentioning

confidence: 99%

Identifying Geographic Areas of Washington, DC, With Increased Potential for Sexual HIV Transmission Among People With HIV With STIs and Concurrent Elevated HIV RNA: Data From the DC Cohort

Byrne

Akselrod

Monroe

et al. 2022

Open Forum Infectious Diseases

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Background The U=U (Undetectable=Untransmittable) campaign advances the goal of ending the HIV epidemic by promoting durable viral suppression and therefore reducing sexual transmission. We used geospatial analysis to assess the potential for sexual HIV transmission by ZIP code of residence in the District of Columbia (DC) using data from DC Cohort Longitudinal HIV Study (DC Cohort), a city-wide cohort of persons with HIV (PWH). Methods DC Cohort participants ages ≥13 were included in the study period between April 1, 2016 and March 31, 2018. Potential for sexual HIV transmission was defined as the proportion of participants with incident sexually transmitted infection (STI - gonorrhea, chlamydia, syphilis) and with HIV RNA ≥200 copies/mL from 9 months prior to 3 months after STI diagnosis. We performed geographic information system (GIS) analysis to determine the ZIP codes with the highest potential for sexual HIV transmission. Results Of 3,467 participants, 367 (10.6%) had at least one incident STI, with 89.4% residing in 11 of the 20 residential ZIP codes in DC. Of the 367 participants with an incident STI, at least one HIV RNA was available for 348 (94.8%). 97 (27.9%) of individuals with an incident STI had HIV RNA ≥200 copies/ml in the defined time window. Of these 97, 66 (68.0%) resided in 5 of the 20 DC ZIP codes. Conclusions In DC, 5 ZIP codes of residence accounted for the majority of the estimated potential for HIV transmission among participants in the DC Cohort. These results support focused neighborhood-level interventions to help end the HIV epidemic.

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Sexually transmitted infections in persons living with HIV infection and estimated HIV transmission risk: trends over time from the DC Cohort

Cited by 17 publications

References 11 publications

Epidemiological risk factors associated with primary infection by Epstein–Barr virus in HIV-1-positive subjects in the Brazilian Amazon region

Epidemiological risk factors associated with primary infection by Epstein–Barr virus in HIV-1-positive subjects in the Brazilian Amazon region

Anatomic Site–Specific Gonorrhea and Chlamydia Testing and Incidence Among People With HIV Engaged in Care at 4 US Clinical Centers, 2014–2018

Identifying Geographic Areas of Washington, DC, With Increased Potential for Sexual HIV Transmission Among People With HIV With STIs and Concurrent Elevated HIV RNA: Data From the DC Cohort

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