The findings and conclusions in these presentations have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy.

Wednesday, May 10, 2006 - 4:30 PM

Asymptomatic Sexually Transmitted Infections (STI) and Risk-Taking Behaviors are Commonly Detected among HIV-Infected Patients in Care: Lessons from the Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy (SUN Study) Cohort

Kenneth H. Mayer1, Keith Henry2, Timothy Bush3, Richard Groger4, Lois Conley3, Jean Richardson5, and John T. Brooks6. (1) Fenway Community Health and Brown University/Miriam Hospital, 7 Haviland Street, Boston, MA, USA, (2) hennepin County Medical Center, Minneapolis, MN, USA, (3) Centers for Disease Control and Prevention, Atlanta, GA, USA, (4) Washington University School of Medicine, St. Louis, MO, USA, (5) Institute for Prevention Research, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA, (6) Divisions of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-45, Atlanta, GA, USA


Background:
Although STI rates in some high-risk groups are rising, prevalence data among U.S. HIV-infected persons are limited.

Objective:
Describe the prevalence of asymptomatic STI among HIV-infected patients in care.

Method:
The SUN Study follows HIV-infected patients receiving primary care at clinics in Denver, Minneapolis, Providence, and St. Louis. At baseline, enrollees complete a behavioral risk questionnaire and provide throat and rectal swabs, and urine samples that are tested for Neisseria gonorrhea and Chlamydia trachomatis by the Aptima NAAT technique. Urine from men and vaginal swabs are tested for Trichomonas by PCR. Blood is screened for syphilis by VDRL or RPR with confirmatory antigen testing.

Result:
Among the first 232 men and 74 women enrolled and fully screened, 13.1% had at least one STI; most infections were asymptomatic. The only STI diagnosed among women was trichomoniasis (14.9%). Among men, the most common STIs were rectal chlamydia (6.9%), oropharyngeal gonorrhea (3.4%), rectal gonorrhea (1.7%), and syphilis (1.7%). In the 6 months before screening, 35.6% of persons reported unprotected vaginal or anal sex with at least one partner and 19.7% had >4 partners. Sociodemographic variables, CD4 cell count, and plasma HIV RNA were not predictive of having an STI, but having multiple partners or unprotected vaginal or anal sex (UVAS) were associated with diagnosis of an STI (both p <0.01). In multivariate analyses (expressed as adjusted odd ratios with 95% C.I.) age <37 years (2.9, 1.7-5.2), having ever used illicit drugs other than marijuana (2.1, 1.1-4.2), using inhaled nitrates in the prior 6 months (2.3, 1.2-4.5), and having >4 partners in the prior 6 months (3.4, 1.8-6.5) were associated independently with UVAS.

Conclusion:
HIV-infected patients in care may often be infected with an asymptomatic STI. Providers should ask about behavioral risks and screen patients at least annually. Interventions to reduce risk taking should be embedded into HIV primary care.

Implications:
Asymptomatic STI are common in HIV-infected patients in care. Providers should screen sexually HIV-infected patients routinely and culturally-specific interventions for secondary prevention are needed.

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