Which HIV-Infected Men who have Sex with Men (MSM) in Care are at Increased Risk for Bacterial Sexually Transmitted Diseases?

Tuesday, March 11, 2008: 11:15 AM
Northwest 1
Kenneth H. Mayer, MD , Fenway Community Health and Brown University/Miriam Hospital, Boston, MA
Margie Skeer, MSW, MPH , Fenway Community Health and Harvard School of Public Health, Boston, MA
Conall O'Cleirigh, PhD , Fenway Community Health and Harvard Medical School/MGH, Boston, MA
Esther Leidolf , Fenway Community Health, Boston, MA
Charles Covahey , Fenway Community Health, Boston, MA
Chris Grasso, MPH , Fenway Community Health, Boston, MA
Rodney VanDerwarker , Fenway Community Health, Boston, MA
Steven A. Safren, PhD , Fenway Community Health and Harvard Medical School/MGH, Boston, MA

Background:
Up to 40% of HIV-infected MSM engage in unprotected anal intercourse, increasing their risk for contracting an STD and their risk of transmitting HIV.

Objective:
To identify which HIV-infected MSM were at highest risk for STD acquisition.

Method:
HIV-infected MSM (n = 501) participating in an HIV prevention study at the largest ambulatory HIV care center in New England completed a computer-administered psychosocial assessment. Clinical information was obtained through electronic medical record extraction. Bivariate and multivariable logistic regression analyses were conducted to determine the odds of having been diagnosed with an STD within the past year.

Result:
Participants were predominantly Caucasian (75.5%) and college educated (51.7%). Their mean age was 41.9 years (SD: 8.3). Participants had an average CD4 cell count of 531 cells/mm3 (SD: 286) and had been diagnosed with HIV for 8.9 years (SD: 6.6); 43.6% of the participants had a detectable viral load (mean plasma HIV-RNA of 13,771 copies/ml). Of the 6.8% of the cohort who had been diagnosed with a bacterial STD in within the past year, 78.1% had syphilis; 55% reported unprotected insertive or receptive anal intercourse with male partners within the past 6 months. In the prior 3 months, 20.1% consumed 5 or more alcoholic drinks per day at least once; 54.1% reported other substance use, including 20.9% using Methamphetamine. In the final multivariable model, only participants who were more recently diagnosed with HIV (OR = 1.08, CI: 1.01 1.15) and who used Methamphetamine within the past 3 months (OR: 2.6, CI: 1.2 6.0) were significantly more likely to have an STD than other MSM participants.

Conclusion:
HIV-infected MSM who are younger (and more recently diagnosed) and using Methamphetamine have the greatest risk for having an STD.

Implications:
STD prevention efforts among HIV-infected MSM should target those who are more recently diagnosed, and those who use substances, especially Methamphetamine.