Background: Previous studies have reported past STI diagnosis as a marker of risk for HIV. Few studies analyze STIs prior to HIV infection using clinical data.
Methods: 1,754 subjects from the U.S. Military Natural History Study cohort with an HIV diagnosis after 1996 were included. STI diagnosis data were collected using ICD-9 codes. Survival plots were created to identify potential patterns of pre-HIV STIs and logrank tests were used to compare groups.
Results: Participants were 43% African-American, 38% Caucasian and 95% male, with low IDU. 423 (24%) subjects had an STI diagnosis before HIV. Participants with an STI before HIV were more likely to be non-Caucasian [p=.023] and in the Navy [p<.001]. Prior to HIV, most recent STIs were gonorrhea (n=149 (35%)), followed by syndromic infection (n=141), viral infection (n=75), syphilis (n=38) and chlamydia (n=20). In survival analyses, time from most recent STI to HIV varied by sex, age at HIV diagnosis, STI type, and number of STIs. The median time to HIV was 2 years among males compared to 1 year among females and 2.4 years among those with gonorrhea compared to 1 year among those with syphilis. There was a decrease in time to HIV as number of pre-STIs increased (median time to HIV: 2.1 years (1-2 STIs), 1.3 years (3-4 STIs) and .8 years (4+ STIs) [p<.001]). Individuals <25 were diagnosed with HIV faster after the most recent STI than individuals > 25 at HIV diagnosis [p<.001].
Conclusions: 24% of participants had an STI before HIV and among those that did, 65% were diagnosed with HIV over one year after their most recent STI. HIV prevention interventions should continue to target those with an STI diagnosis but further studies are needed to identify these other high-risk populations that are not diagnosed with STIs before HIV.