417. Uncontrolled HIV Infection is a Risk Factor for the Acquisition of other Sexually-Transmitted Infections in Adolescents and Young Adults
Session: Poster Abstract Session: Pediatric HIV
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Brownstein Poster.pdf (173.9 kB)
  • Background:

    Half of the 19 million new sexually-transmitted infections (STIs) and 26% of all new HIV infections each year in the United States occur in youth 13-24 years of age. Co-STIs are a risk factor for HIV acquisition and transmission, but there are a lack of data to assess treatment and virologic control of HIV as an intervention for reducing STI transmission. 

    Methods:

    This was a single-centered, retrospective analysis of HIV-infected sexually-active adolescents and young adults from January 2009 to December 2011, designed to compare incidence of STIs among patients with controlled and uncontrolled HIV and identify associated risk factors. Controlled HIV infection was defined as a 2-year mean HIV-RNA viral load of <500 copies/ml and CD4+ T-cell count >200 cells/mm3. Socio-demographic, sexual history, substance abuse and HIV variables were evaluated. 

    Results:

    Of the 206 enrolled subjects, 59% were male and 92% were African American with a mean age of 21 years (2.1 SD). 64% were horizontally-infected and 19% met the definition of controlled HIV.  44% were men having sex with men with a mean age at first sexual encounter of 15.2 years (2.6 SD). 43% reported having >5 lifetime sexual partners, 69% reported using condoms, 23% had a history of sexual abuse and 58% admitted drug use. 74% contracted an STI during the study period and subjects with uncontrolled disease had a significantly higher STI contraction rate (p=0.008), number of STIs (p=0.01), number of sexual partners (p=0.008) and were more likely to be horizontally-infected (p=0.001). Use of antiretroviral therapy was higher among patients who had no STIs compared to those with ≥1 (p=0.04). In an ordinal logistic regression model  adjusting for controlled and uncontrolled HIV status, having ≥1 STI was associated with older age (p=0.036), female gender (p<0.001), having >5 sexual partners (6-10 partners p=0.012; >10 partners p=0.006) and homosexual orientation (p=0.004).  Subjects with uncontrolled HIV infection had 2.3 times (95% CI 1.008, 5.274) the odds of having ≥1 STIs compared to a subject with controlled HIV.   

    Conclusion:

    Uncontrolled HIV in adolescents and young adults appear to increase incidence of co-STIs. Interventions aimed at improving HIV treatment compliance are urgently needed in this population.

    Pamela S. Brownstein, MD1, Scott E. Gillespie, MS2, Traci Leong, PhD3, Rana Chakraborty, MD, PhD4, Allison R. Eckard, MD4 and Andres Camacho-Gonzalez, MD, MSc.4, (1)Department Of Pediatrics, Emory University School of Medicine, Atlanta, GA, (2)Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, (3)Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, (4)Department of Pediatrics, Division of Pediatric Infectious Diseases, Emory University School of Medicine, Atlanta, GA

    Disclosures:

    P. S. Brownstein, None

    S. E. Gillespie, None

    T. Leong, None

    R. Chakraborty, None

    A. R. Eckard, BMS: Grant Investigator, Research grant
    GSK: Grant Investigator, Research grant
    Cubist: Grant Investigator, Research grant
    Gilead: Consultant, Speaker honorarium

    A. Camacho-Gonzalez, BMS: Grant Investigator, Research grant

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