High Rates of Asymptomatic STDs in HIV Patients

By Brian Boyle, MD

Recent reports have been made of increases in STD rates and associated risk taking behaviors in HIV+ individuals. The prevalence of, and risk factors for, STD and unprotected sex among HIV+ patients in clinical care were explored in a study presented at the 13th CROI.

The SUN Study is a prospective cohort study of HIV+ patients receiving primary care at clinics in Denver, Minneapolis, Providence, and St. Louis. Data and laboratories are collected at each clinical encounter.

Among the first 151 men and 51 women enrolled and fully screened, 12.4% had at least one STD, with 13.7% of the women having trichomoniasis, but no other STI. Among men, the most common STD were rectal chlamydia (7.3%), rectal gonorrhea (2.6%) and syphilis (2.6%); however, these were mainly clustered among men who have sex with men and among heterosexual men only 2% had and STD.

Over 1/3 (36.1%) reported unprotected vaginal or anal sex with at least one partner, and 19.4% had at least 4 partners, in the prior 6 months. Independent risk factors for STDs included persons who used drugs in the past 30 days, those who had multiple partners, or unprotected vaginal or anal sex (UVAS) were more likely to have a new STD (p <0.01).

Multivariate analyses found that that age <36 years, having ever used amphetamines, use of drugs other than marijuana in the prior 6 months, and having >4 partners in the prior 6 months were independently associated with increased risk. For men, ever having used Viagra®, using poppers in the last 6 months, age <36 years and having >4 partners in the prior 6 months were also associated with STDs.

The authors conclude, "Asymptomatic [STD] were frequent among these HIV+ patients in care. Providers should screen patients routinely and ask about behavioral risks. Interventions to reduce risk taking should be embedded into routine HIV primary care."

02/14/06

Reference
K Mayer and others. Asymptomatic Sexually Transmitted Infectious (STI) and Risk Taking Behaviors are Commonly Detected among HIV-infected Patients in Care: Lessons from the Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy (SUN Study) Cohort. 13th Conference on Retroviruses and Opportunistic Infections. Denver, CO. February 5-8, 2006. Abstract 802.