Risk of HIV diagnosis following bacterial sexually transmitted infections in Tennessee, 2013-2017.

Abstract

BACKGROUND\nData on associations between sexually transmitted infections (STIs) and incident HIV diagnoses beyond men who have sex with men (MSM) are lacking. Identifying STIs associated with greatest risk of incident HIV diagnosis could help better target HIV testing and prevention interventions.\n\n\nMETHODS\nSTI and HIV surveillance data from individuals ≥13 years in Tennessee from 1/2013-12/2017 were cross-matched. Individuals without diagnosed HIV, but with reportable STIs (chlamydia, gonorrhea, syphilis) were followed from first STI diagnosis until HIV diagnosis or end of study. Cox regression with time-varying STI exposure was used to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for subsequent HIV diagnosis; results were stratified by self-reported men who have sex with men (MSM).\n\n\nRESULTS\nWe included 148,465 individuals without HIV (3,831 MSM; 144,634 non-MSM, including heterosexual men and women) diagnosed with reportable STIs; 473 had incident HIV diagnoses over 377,823 person-years (p-y) of follow-up (median 2.6 p-y). Controlling for demographic and behavioral factors, diagnoses of gonorrhea, early syphilis, late syphilis, and STI coinfection were independently associated with incident HIV diagnosis compared to chlamydia. Early syphilis was associated with highest HIV diagnosis risk overall (aHR 5.5, 95% CI: 3.5-5.8); this risk was higher for non-MSM (aHR 12.3, 95% CI: 6.8-22.3) versus MSM (aHR 2.9, 95% CI: 1.7-4.7).\n\n\nCONCLUSIONS\nWhile public health efforts often focus on MSM, non-MSM with STIs are also a subgroup at high risk of incident HIV diagnosis. Non-MSM and MSM with any STI, particularly syphilis, should be prioritized for HIV testing and prevention interventions.