1567. STI Diagnosis Prior to HIV Infection May Severely Underestimate HIV Risk Among Active Duty Military Members
Session: Poster Abstract Session: Clinical Infectious Diseases: Sexually Transmitted Infections
Saturday, October 10, 2015
Room: Poster Hall
  • Glancey_IDSA STI_HIV Poster Draft_2015_10_1.pdf (386.7 kB)
  • Background:

    Prior sexually transmitted infection (STI) is thought to be a strong indicator of risky sexual risk behavior and a predisposing factor for future HIV infection. We used a large dataset containing STI diagnoses of military active duty personnel, who are routinely screened for HIV approximately every 2 years, to assess STI diagnoses in relation to HIV.


    Using ICD-9 diagnosis codes, we analyzed the medical records of 100,005 individuals from all service branches, divided in equal cohorts (n=6,667) by year of military accession between 1997-2011, and followed from entry into the military to exit.  We identified and characterized HIV+ individuals into three mutually exclusive groups that could represent varying risk profiles: 1) diagnosed with at least one STI before HIV (prior STI), 2) diagnosed only with HIV and/or a concomitant STI at HIV diagnosis (STI/HIV only), or 3) diagnosed with HIV first then later diagnosed with at least one more STI (post STI).   Categorical variables were compared using Fisher’s exact test.


    Of the 100,005 randomly selected active duty members, with an average follow-up of 4.9 years, 116 were diagnosed with HIV.   Compared to HIV-negative individuals, people diagnosed with HIV had a longer average follow-up time (7.7 years) and were more likely to be male (84%) and African American (46%) .  19 people (16%) fell into the prior STI group, 72 (62%) into the STI/HIV only group, and 25 (22%) into the post STI group.  20% of African Americans had a prior STI compared to 10% of Caucasians.  Age at entry, age at HIV, education achieved, marital status, and region did not appear to be different between groups.


    In this survey of military personnel, only one-sixth of newly HIV-positive individuals were diagnosed with an STI prior to HIV diagnosis.  Thus, focusing HIV prevention efforts only towards those with an STI would miss many individuals at risk for HIV infection.   Larger prospective studies incorporating behavioral risk assessment are required to understand how these risk profiles differ in order to target specific interventions to these varying risk groups.

    Margaret Glancey, MSPH1,2, Brian Agan, MD, FIDSA1,2, Xiuping Chu, MSCS, MSME1,2, Octavio Mesner, MS1,2, Jose Sanchez, MD, MPH3, Anuradha Ganesan, MD, MPH2,4,5, Robert Deiss, MD1,2,6 and Grace Macalino, PhD1,2, (1)Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, (2)Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, (3)Armed Forces Health Surveillance Center, Silver Spring, MD, (4)Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, MD, (5)Walter Reed National Military Medical Center, Bethesda, MD, (6)Division of Infectious Diseases, Naval Medical Center of San Diego, San Diego, CA


    M. Glancey, None

    B. Agan, None

    X. Chu, None

    O. Mesner, None

    J. Sanchez, None

    A. Ganesan, None

    R. Deiss, None

    G. Macalino, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.