B P Mulhall1,2, S T Wright1, N De La Mata1, D Allen3, K Brown2,4,5, B Dickson6, M Grotowski7, E Jackson8, K Petoumenos1, R Foster1,9, T Read10, D Russell11,12, D J Smith13, D J Templeton1,14, C K Fairley10,12, M G Law1. 1. The Kirby Institute, University of New South Wales, Sydney, NSW, Australia. 2. University of Sydney, Camperdown, NSW, Australia. 3. Holden Street Sexual Health Clinic, Gosford, NSW, Australia. 4. Illawarra Sexual Health Services, Warrawong, NSW, Australia. 5. University of Wollongong, Wollongong, NSW, Australia. 6. Caradata, Arundel DC, Qld, Australia. 7. Tamworth Sexual Health, Clinic 468, HNEAHS, NSW, Australia. 8. Nepean/Blue Mountains Sexual Health, Nepean Hospital, Kingswood, NSW, Australia. 9. Sydney Sexual Health Centre, Sydney, NSW, Australia. 10. Melbourne Sexual Health Centre, Alfred Hospital, Prahran, Vic., Australia. 11. Cairns Sexual Health Service, Cairns, Qld, Australia. 12. Central Clinical School Monash University, Alfred Hospital, Melbourne, Vic., NSW, Australia. 13. Lismore Sexual Health Services, Lismore, NSW, Australia. 14. RPA Sexual Health, Camperdown, NSW, Australia.
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.
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.
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