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Risk of Subsequent HIV Infection Following Sexually Transmissible Infections Among Men Who Have Sex With Men

Brendan L Harney1,2, Paul A Agius1,2,3, Carol El-Hayek1,2

  • 1Disease Elimination Program, Burnet Institute, Melbourne, Australia.

Open Forum Infectious Diseases
|October 30, 2019
PubMed
Abstract

Insights

A history of rectal gonorrhea, especially repeated infections, significantly increases HIV risk in men who have sex with men (MSM). This highlights the need for targeted HIV prevention strategies for MSM with gonorrhea.

Area of Science:

  • Public Health
  • Epidemiology
  • Infectious Diseases

Background:

  • Increasing rates of HIV and bacterial sexually transmitted infections (STIs) among men who have sex with men (MSM) globally.
  • Established link between HIV and other STIs, but the impact of cumulative STI history on HIV risk is understudied.
  • Understanding STI history's role in HIV risk is crucial for elucidating mechanisms of elevated HIV acquisition in MSM.

Purpose of the Study:

  • To investigate the association between a cumulative history of STIs and the risk of subsequent HIV infection among MSM.
  • To quantify the impact of single and repeated rectal gonorrhea infections on HIV risk in this population.

Main Methods:

  • Analysis of data from HIV-negative MSM attending primary care clinics in Melbourne, Australia (2007-2014).
  • Inclusion criteria: 2 or more HIV and STI tests during the study period.
  • Discrete time survival analyses, controlling for sexual behaviors, to estimate the effect of prior STIs and cumulative STI history on HIV risk.

Main Results:

  • 227 out of 8941 (2.5%) MSM were diagnosed with HIV during follow-up.
  • A cumulative history of repeated rectal gonorrhea infections was strongly associated with increased HIV risk (aHR, 6.27; 95% CI, 2.68-14.50).
  • A single rectal gonorrhea infection also showed an association with increased HIV risk (aHR, 2.09; 95% CI, 1.15-3.79).

Conclusions:

  • Both single and repeated rectal gonorrhea infections are independently linked to a higher risk of HIV acquisition in MSM.
  • MSM with any history of rectal gonorrhea, particularly recurrent infections, should be prioritized for HIV preventive interventions.
  • Findings underscore the importance of STI screening and management in reducing HIV transmission among MSM.
Keywords:
HIVMSMSTIchlamydiagonorrhoeasyphilis

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