AEGiS-13IAC: Ulcerative and non-ulcerative STD increase HIV seroincidence in the US: Results from a longitudinal study in New Orleans, Louisiana, 1990-1998.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Ulcerative and non-ulcerative STD increase HIV seroincidence in the US: Results from a longitudinal study in New Orleans, Louisiana, 1990-1998.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. ThOrC725)

Hanson J, Hassig SE, Rice JC, Farley TA
J. Hanson, Tulane University, 4225 Camp St, New Orleans, LA, 70115, United States, Tel.: +504-568-5013, Fax: +504-568-5760, E-mail: hans117w@yahoo.com

BACKGROUND: The objective of this study was to assess the determinants of HIV seroconversion in STD clinic patients, specifically the potential role of ulcerative and non-ulcerative STD in HIV transmission.

METHODS: We conducted a medical record-based analysis of a cohort of individuals attending a New Orleans STD clinic between 1990 and 1998. Multiple Cox regression was used to identify STD-related risk factors for HIV seroconversion, while controlling for the effects of behavioral risks. In addition to an overall model, a subset of individuals with no history of ulcerative STD was analyzed in order to examine more closely potential effects of non-ulcerative STD.

RESULTS: Of 10,879 individuals, 135 (1.2%) seroconverted. The seroincidence rate was .485 per 100 person-years. In the main multivariate model, having a recent syphilis or GUD diagnosis was associated with increased risk of seroconversion in males and females (hazard ratio (HR), 4.65; 95% CI, 2.13-10.15, and HR, 5.02; 95% CI, 1.94-12.99, respectively). Among individuals with no history of GUD or syphilis, a recent gonorrhea diagnosis was associated with more than a two-fold increase of risk of seroconversion among males (HR, 2.77; 95% CI, 1.48-5.18), but no such increase was observed among females. Independent behavioral risk factors included male-to-male sex (HR, 3.33; 95% CI, 2.05-5.43) and exchanging money or drugs for sex among males (HR, 1.55; 95% CI, 1.02-2.36); and sex with an HIV-positive partner among females (HR, 10.80; 95% CI, 1.26-92.75).

CONCLUSION: This study suggests that the presence of ulcerative or non-ulcerative STD is associated with elevated risk of HIV transmission in this predominantly heterosexual US population. Given the high prevalence of gonorrhea and other non-ulcerative conditions in this increasingly critical risk group, comprehensive STD control programs may be particularly effective tools for HIV prevention.

Keywords: AEGIS, HIV, HIV Infections, HIV Seropositivity, Longitudinal Studies, Acquired Immunodeficiency Syndrome, Risk Factors, Prevalence, Heterosexuality, Gonorrhea, Ulcer, HIV Antibodies, Louisiana, Human, Female, Male, immunology
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