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New sexually transmitted diseases in HIV-infected patients: markers for ongoing HIV transmission behavior.
Journal of Acquired Immune Deficiency Syndrome 2003;33(2):247-252.
Erbelding EJ, Chung S, Kamb ML, Irwin KL, Rompalo AM.
Abstract
OBJECTIVE: The objective of this study was to describe the rate of new sexually
transmitted diseases (STDs) among HIV-infected patients and to define the
behavioral and clinical characteristics of HIV-infected patients who return
with a new STD in follow-up. DESIGN: The study design was a record-based
clinical cohort study focusing on patients testing HIV-seropositive in the
STD clinics of Baltimore, Maryland from 1993 to 1998. METHODS: The authors
identified those HIV-infected patients later diagnosed with an STD in follow-up
and compared their demographic, behavioral, and clinical characteristics
with those who were not diagnosed with an STD in follow-up. RESULTS: Of 796
men and 354 women with HIV infection, 13.9% of men and 11.9% of women were
diagnosed with an STD after their initial HIV diagnosis. HIV-infected men
returned with a new STD at a rate of 7 cases per 100 person-years; HIV-infected
women returned at a rate of 5.6 cases per 100 person-years. In men, multiple
sex partners and sex worker contact were associated with a subsequent STD
diagnosis (OR = 1.67, p =.037; OR = 1.82, p =.015, respectively). In women,
age younger than 30 years was associated with the diagnosis of an STD after
the diagnosis of HIV infection (OR = 2.94, p =.0009). CONCLUSIONS: Patients
diagnosed with HIV in an STD clinic setting commonly return with new STDs
in follow-up, suggesting continued exposure of HIV to others. More intensive
screening and counseling interventions focused on STD prevention in those
with HIV infection is a necessary HIV prevention strategy.