Abstract Body

Sexually transmitted infections (STIs) remain a public health concern because of their interaction(s) with HIV. Infection with STIs among HIV-infected persons may reduce CD4+ level and increase HIV RNA in blood plasma and semen, thus increasing the potential for HIV transmission. In HIV-uninfected individuals, STIs increase genital inflammation that may enhance HIV acquisition during sex. Among both HIV-uninfected and HIV-infected individual, infection with any STI is a marker of unsafe sexual practices.

In the HPTN 052 study, STIs were evaluated in both HIV-infected index cases and their HIV-uninfected partners at enrollment and at yearly follow-up visits. Genital swabs were collected at the sites and shipped to HPTN Central Laboratory for etiology determination. In this analysis, our definition for STI was based on any infection with hepatitis B, Chlamydia trachomatis, Neisseria Gonorrhea, Syphilis, or Trichomonas vaginalis. We used log binomial regression models to identify factors associated with prevalent STIs. Generalized Estimating Equations models with Poisson link function were used to compare STI incidence between HIV-infected index cases and HIV-uninfected partners, stratified by gender.

10.4% of the participants had STIs at enrolment. The prevalence of STIs (13.6 vs 7.2) was higher in HIV-infected index cases compared to HIV-uninfected partners. Being female (prevalence ratio (PR) = 1.29; 95% CI: 1.01─1.66) or unmarried (PR = 1.61; 95% CI: 1.03─2.51) was associated with prevalent STIs. STI incidence during follow up is presented in the Table. Compared to HIV-uninfected male partners, HIV-infected female index cases had a higher risk of STI acquisition (Incidence Rate Ratio (IRR) = 2.50; 95% CI: 1.74─3.60).

STIs are common among HIV-serodiscordant couples. HIV-infected female index cases are more likely to acquire STIs from their HIV-uninfected partners or other partners.  While we are implementing HIV prevention interventions for HIV-uninfected people, we should also intensify targeted STI prevention interventions, especially among HIV-infected women.