Incident STIs as a biomarker for high risk sexual behavior after entering care in individuals

diagnosed with acute HIVCope AB, Crooks A, Kuruc J, Sugarbaker A, Hightow-Weidman L, Eron J, Gay C

Study Aim: To assess predictors of STI acquisition and the effect of time since entry into care on STI incidence in patients diagnosed with acute HIV infection (AHI) in care and receiving targeted and consistent risk reduction messaging

Methods: AHI was defined as a negative or indeterminate immunoassay with

reproducibly detectable HIV identified by amplification methods Initiated HIV care at the UNC HIV Clinic within 60 days of AHI

diagnosis. Patients were followed up for at least 3 months post enrollment.

Tested for at least 1 of the following STIs at least 28 days after entering care at UNC: Neisseria gonorrhoeae (GC) Chlamydia trachomatis (CT) Trichomonas vaginalis (TV) Primary and secondary syphilis

Poisson regression models, using generalized estimating equations, were fit to estimate incidence rates (IR) and robust 95% confidence intervals (CI).

Results 77 patients were identified with the following demographics:

Median age 25 years, 82% MSM, and 58% African-American, Median Follow-up 4 years 44 STIs were diagnosed among 24 patients over 382 person-years

resulting in an incident rate of 8.1 per 100 person-years (range per patient 1-7 STIs)

Diagnosis of a STI ≤ 8 weeks before AHI diagnosis had a statistically significant association with being diagnosed with at least 1 incident STI (p=0.03)Crude & adjusted STI IRs by time since

entering carePatients with detectable VL (>50 copies/ml) by treatment status at time of STI diagnosis (N=8)

* Adjusted for age, sexual risk group, STI diagnosis within 8 weeks of AHI diagnosis**Crude p-for-trend=0.3. Adjusted p-for-trend=0.4

Median

Maximum Value (152,000 c/ml) not shown on figure

Conclusions

STI incidence was high, with an overall IR of 8.1/100 p-y which indicates that ongoing risk behavior is occurring, despite consistent, directed risk-reduction messaging. Annual STI screening is recommended.

All STIs were diagnosed more than 1 year after AHI diagnosis, suggesting a change in sexual behavior more than 1 year after diagnosis.

1/3 of patients diagnosed with a STI were viremic at the time of STI diagnosis. ART in AHI should be considered for HIV prevention.