Risk factors associated with incident sexually transmitted infections in HIV-positive patients in the Australian HIV Observational Database: a prospective cohort study

Authors

Brian P. Mulhall, University of New South Wales
Stephen Wright, University of New South Wales
N De La Mata, University of New South Wales
Debbie Allen, Holden Street Sexual Health Clinic, Gosford
Katherine M. Brown, University of WollongongFollow
Bridget Dickson, Caradata, Queensland
Miriam Grotowski, Tamworth Sexual Health
Eva Jackson, Nepean Hospital
Kathy Petoumenos, University of New South Wales
R Foster, University of New South Wales
Timothy Read, The Alfred Hospital
Darren Russell, Cairns Sexual Health Service
David J. Smith, Lismore Sexual Health Services
David J. Templeton, University of New South Wales
Christopher K. Fairley, Alfred Hospital
Matthew G. Law, University of New South Wales

RIS ID

106642

Publication Details

Mulhall, B. P., Wright, S. T., De La Mata, N., Allen, D., Brown, K., Dickson, B., Grotowski, M., Jackson, E., Petoumenos, K., Foster, R., Read, T., Russell, D., Smith, D. J., Templeton, D. J., Fairley, C. K. & Law, M. G. (2016). Risk factors associated with incident sexually transmitted infections in HIV-positive patients in the Australian HIV Observational Database: a prospective cohort study. HIV Medicine, 17 (8), 623-630.

Abstract

Objectives We established a subcohort of HIV-positive individuals from 10 sexual health clinics within the Australian HIV Observational Database (AHOD). The aim of this study was to assess demographic and other factors that might be associated with an incident sexually transmitted infection (STI). Methods The cohort follow-up was from March 2010 to March 2013, and included patients screened at least once for an STI. We used survival methods to determine time to first new and confirmed incident STI infection (chlamydia, gonorrhoea, syphilis or genital warts). Factors evaluated included sex, age, mode of HIV exposure, year of AHOD enrolment, hepatitis B or C coinfection, time-updated CD4 cell count, time-updated HIV RNA viral load, and prior STI diagnosis. Results There were 110 first incident STI diagnoses observed over 1015 person-years of follow-up, a crude rate of 10.8 [95% confidence interval (CI) 9.0-13.0] per 100 person-years. Factors independently associated with increased risk of incident STI included younger age [≥ 50 vs. 30-39 years old, adjusted hazards ratio (aHR) 0.4; 95% CI 0.2-0.8; P < 0.0001]; prior STI infection (aHR 2.5; 95% CI 1.6-3.8; P < 0.001), and heterosexual vs. men who have sex with men (MSM) as the likely route of exposure (aHR 0.2; 95% CI 0.1-0.6; P < 0.001). Conclusions In this cohort of individualsbeing treated with antiretroviral drugs, those who were MSM, who were 30-39 years old, and who had a prior history of STI, were at highest risk of a further STI diagnosis.