To gain a better understanding of factors associated with HIV- and STD-transmitting behavior among persons living with HIV, the team estimated STD prevalence and incidence, as well as associated risk factors, among a diverse sample of HIV-positive patients in primary care.
The researchers analyzed data from 557 participants in the SUN Study, a prospective observational cohort of HIV-infected adults in primary care in four US cities. At enrollment and six months later, participants completed an audio computer-assisted self-interview about their sexual behavior; in addition, they were screened for genitourinary, rectal and pharyngeal Neisseria gonorrhoeae and Chlamydia trachomatis infections by nucleic acid amplification testing, and for serologic evidence of syphilis. Women provided cervicovaginal samples, and men provided urine to screen for Trichomonas vaginalis by polymerase chain reaction.
At enrollment, 13 percent of participants had a prevalent STD; six months later, 7 percent had an incident STD. The most commonly diagnosed infections were rectal chlamydia, oropharyngeal gonorrhea, and chlamydial urethritis among the men, and trichomoniasis among the women. Excluding trichomoniasis, 94 percent of the incident STDs were diagnosed among men who have sex with men (MSM). Polysubstance abuse, other than marijuana, and having four or more sex partners in the six months prior to testing were associated with the diagnosis of an incident STD.
"STDs were commonly diagnosed among contemporary HIV-infected patients receiving routine outpatient care, particularly among sexually active [MSM] who used recreational drugs," the authors concluded. "These findings underscore the need for frequent STD screening, prevention counseling, and substance abuse treatment for HIV-infected persons in care."