AEGiS-15IAC: Sexually transmitted diseases (STD) in the I.Co.N.A. (Italian cohort naïve antiretrovirals) study: prevalence and incidence on 5,422 patients.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Sexually transmitted diseases (STD) in the I.Co.N.A. (Italian cohort naïve antiretrovirals) study: prevalence and incidence on 5,422 patients.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. WeOrB1330)

d'Arminio-Monforte A, Cicconi P, Cozzi-Lepri A, Matteelli A, Orlando G, Alessandrini A, Mena M, Moioli MC, Ortolani P, Bertelli D, Montroni M, Moroni M
University, Milan, Italy

BACKGROUND: Data on STD are poorly recorded in cohorts of HIV pts.

METHODS: STDs recorded in ICoNA are: syphilis(unspecified if primary), acute hepatitis B(HBV), gonorrhoea(gon), HSV genital ulcers, genital candidiasis, condilomata, other, and serologic syphilis test seroconversion(syph-t sc). The frequency of STD at enrolment and before first HIV+ test was calculated. Incidence rates of first acute STD (HBV, gon, syph-t sc) were calculated according to on- or off-HAART, current CD4 ( 200/cmm)and viral load( 500 cps/mL) and demographics. Standard Poisson regression model was used for the multivariable analysis.

RESULTS: 635/5,422 (12%) pts suffered from >=1 STD before enrolment; in 442 (8%) pts STD was diagnosed before first HIV-pos test (median 260 wks, range 2-2075). In these pts, the most frequent STDs were HBV (52%) and syphilis (25%). Analysis of the incidence of acute STD focussed on 94/5.422 pts either with HBV (n=27), gon (n=4), or evidence for syph-sc (n=63). Pts were 35 years old (range: 21-79),70% were males; 41% were IVDU, 19% homosexuals (homosex), 35% heterosexuals. They were followed up for 17,236 person years (pys). 9,051 pys were spent off-HAART, during which 51 events occurred, for a rate of 0.6/100 pys (95%CI:0.4-0.7); 8,184 pys were spent on-HAART, during which 43 events occurred for a rate of 0.5/100 pys (95%CI:0.4-0.7). The crude rate ratio (RR) of acute STD on/off HAART was 0.9 (95%CI:0.6-1.4, p=0.74). Females showed a lower risk than males (RR= 0.3;95%CI:0.1-0.5, p=0.0001), and homosex were at higher risk (RR=3.9;95%CI:2.4-6.3, p=0.0001 vs. IVDU). No association was found between age, CD4 or viral load and risk of STD. These results held true after adjustment in a multivariable model (RR for females: 0.5, 95%CI:0.2-0.9, p=0.04; RR for homosex: 3.6, 95%CI:2.2-5.8, p=0.0001).

CONCLUSIONS: The occurrence of a STD may be a hallmark of HIV. Homosex are at higher risk of acute STD. Use of HAART did not seem to be associated with a reduced risk of acute STD.

Keywords: AEGIS, Prevalence, Incidence, Sexually Transmitted Diseases, Syphilis, Gonorrhea, Antiretroviral Therapy, Highly Active, HIV Seropositivity, Hepatitis B, Acquired Immunodeficiency Syndrome, Humans, Female, Male, epidemiology

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