The District of Columbia (DC) has one of the highest HIV infection rates among metropolitan areas in the US. Although the number of new sexually transmitted infections (STI) in DC has remained stable in women and men who have sex with women between 2007 and 2013, there has been an increase in new syphilis cases in men who have sex with men (MSM). This study aims to identify the prevalence and incidence of STIs and hepatitis B/C in HIV-infected people enrolled in the DC Cohort, and to determine factors associated with STIs.
We conducted a retrospective cohort analysis inclusive of all individuals enrolled in the DC Cohort (a longitudinal observational cohort of HIV infected persons) between 2011 and 2014. We measured the prevalence at enrollment of hepatitis B/C, as well as the incidence of syphilis, gonorrhea, Chlamydia and hepatitis B/C, defined by diagnosis code and laboratory data. Using chi-square and Wilcoxon rank sum tests, we also examined factors associated with STIs including demographics, mental health conditions or drug dependence, and CD4 and viral load.
We analyzed data for 6730 DC Cohort enrollees consented on or before December 31, 2014. Median age at enrollment was 47.2 years (IQR 36.8 – 54.6); 72.7% were men, and 38.6% MSM. At the time of consent, 232 (3.5%) had hepatitis B, and 573 (8.5%) had hepatitis C. Among enrollees, 16.4% (29.5% of MSM) had ever been diagnosed with syphilis. Over a median follow-up of 32.8 months, incident gonorrhea occurred in 3.3% of participants (7.2% of MSM), Chlamydia in 3.5% (7.0% of MSM), hepatitis B in 1.3% (1.5% of MSM), and hepatitis C in 4.0% (2.6% of MSM). Factors significantly associated with incident gonorrhea and Chlamydia (p≤0.005) included age 18-34, male gender, MSM, non-Hispanic white race/ethnicity, temporary or unstable housing, Medicaid, and current alcohol/substance use. CD4 nadir, but not CD4 at enrollment, was also associated (p<0.05) with incident gonorrhea and Chlamydia.
Incident STIs remain a significant cause of morbidity and reflect ongoing HIV transmission risk among HIV-infected individuals receiving care in DC. Public health interventions focused on secondary prevention of STIs and subsequent transmission of HIV should target the highest risk populations.
A. Weintrob, None
M. Siegel, None
D. Parenti, None
D. Benator, None