Program Schedule

1752
Incident Genitourinary and Extragenital Gonococcal and Chlamydial infections in a Racially Diverse Well Characterized Cohort of HIV-infected Persons with Free Access to Care and Counseling

Session: Poster Abstract Session: Sexually Transmitted Infections: Epidemiology, Screening, and Management
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • Poster Final.pdf (275.1 kB)
  • Background:

    Asymptomatic genitourinary (GU) and extragenital chlamydia (CT) and gonococcal (GC) co-infections are a common problem in HIV-infected persons. Studies suggest ethnic minorities are disproportionately affected.   We examined incidence, trends and risk factors for GC/CT co-infections in a racially diverse cohort of HIV-infected persons with free access to healthcare and counseling, the US Military HIV Natural History Study (NHS)

    Methods:

    Urine nucleic acid amplification testing (NAAT) was implemented in 2006; whereas willing NHS subjects have undergone extragenital NAATs beginning in 2012.  Incident GC/CT was defined as infections acquired ≥ 6 months after HIV diagnosis.  A multivariate Cox proportional hazards model was used to evaluate risk factors associated with incident GC/CT infections.  Rates and hazard ratios (HR) are reported with 95% confidence intervals.

    Results:

    Between 2006 and 2014, 2082 subjects [94% male, 40% White] contributed 237 cases of GU GC/CT. 108 cases of extragenital GU GC/CT (rectal-73, pharyngeal 35) were observed in 1955 men. The incidence  of GU GC/CT per 100 PY of follow-up for the time periods 2006-2009, 2010-2013, were 2.0 and 2.7 respectively.  The incidence of extra genital GC/CT was 2.8/100 PY in 2012 and 6/100 PY in 2013.  Male gender {HR 2.63 [1.16-5.99]}, and younger age {per 10 year increase; HR 0.26 [0.20-0.33]} were associated with GU GC/CT infections; in turn ART use {HR 0.81 [0.78-0.83]} was associated with reduced risk. Extragenital infections were associated with younger age {ref per 10 year increase; HR 0.17 [0.11-0.25]}, ART use was associated with reduced risk {HR 0.83 [0.78-0.87]}. Race was not associated with either GU {Ref White: non White; HR 1.20 [0.88-1.65]} or extragenital GU GC/CT infections {Ref White: non White; HR 1.05 [0.67-1.65]}.

    Conclusion:

    The burden of asymptomatic GC/CT infections in the NHS is substantial, underscoring the importance of screening programs for asymptomatic individuals. Younger men were disproportionately affected, emphasizing the need for tailored prevention in positive programs targeting these at-risk groups. Ethnicity was not associated with incident GC/CT infections. Free access to healthcare and counseling may help mitigate the observed ethnic disparities in GC/CT infections.

    Tida Lee, MD, PhD1, Xun Wang, MS2, Jason Okulicz, MD3,4, Robert Deiss, MD5,6, Timothy Whitman, MD1,2, Mary Bavaro, MD2,7, Tahaniyat Lalani, MBBS, MHS2,8, Tomas Ferguson, MD2,9, Thomas O'bryan2,10, Brian Agan, MD4, Grace Macalino, PhD2 and Anuradha Ganesan, MBBS, MPH1,2, (1)Walter Reed National Military Medical Center, Bethesda, MD, (2)Infectious Disease Clinical Research Program, USUHS, Rockville, MD, (3)Infectious Disease Service, San Antonio Military Medical Center, Fort Sam Houston, TX, (4)Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, (5)Naval Medical Center San-Diego, SanDiego, CA, (6)Infectious Disease Clinical Research Program, Uniformed Services University, Bethesda, MD, (7)Naval Medical Center San Diego, San Diego, CA, (8)Naval Medical Center Portsmouth, Portsmouth, VA, (9)Tripler Army Medical Center, Tripler AMC, HI, (10)San Antonio Military Medical Center, Fort Sam Houston, TX

    Disclosures:

    T. Lee, None

    X. Wang, None

    J. Okulicz, None

    R. Deiss, None

    T. Whitman, None

    M. Bavaro, None

    T. Lalani, None

    T. Ferguson, None

    T. O'bryan, None

    B. Agan, None

    G. Macalino, None

    A. Ganesan, None

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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