Huhn Gregory D, McIntyre Anne F, Broad Jennifer M, Holmes Steve W, Studzinski Alice, Rabins Charlie, Dworkin Mark S
Ruth M Rothstein CORE Center, Cook County Bureau of Health, Rush University Medical Center, Chicago, Illinois, USA.
Sex Transm Dis. 2008 Aug;35(8):731-7. doi: 10.1097/OLQ.0b013e31817f97a0.
We evaluated Illinois and Chicago Departments of Public Health surveillance databases to determine risk factors associated with newly diagnosed HIV among persons with bacterial sexually transmitted diseases (STDs).
Test results for Chlamydia, gonorrhea, early syphilis (primary, secondary, and early latent), and HIV from public health clinics in Illinois in 2002 were merged with demographic and behavioral survey data collected during patient visits. STD was defined as any positive non-HIV result.
Among 43,517 patient encounters, 5814 (13.4%) had positive STD test results. There were 308 (0.7%) positive new HIV test results, of which 71 (23.1%) had concomitant infection with an STD. Compared with STD-positive, HIV-negative cases, age >30 years (OR = 1.9, 95% CI, 1.0,4.4), men who have sex with men (MSM) (OR = 22.2, 95% CI 11.3-43.7), and bisexual male (OR = 22.4, 95% CI 7.8-64.8) were independently associated with STD and HIV coinfections. Among distinct STDs, syphilis (n = 438) was the least frequent (7.5%), but was reported in the highest proportion (10.1%) of all new HIV infections and conferred the greatest risk (OR = 11.0, 95% CI 7.7-15.8) for newly diagnosed HIV.
MSM were at increased risk for newly diagnosed HIV with STD coinfection. Persons with a concomitant STD and HIV were older than US populations that generally constitute the greatest proportion of STD cases. These results highlight the role in particular of syphilis among populations at high risk for HIV transmission. Public health interventions targeting MSM and older adults for effective testing and prevention strategies are critically needed within high-risk networks for cotransmission of STDs and HIV.
我们评估了伊利诺伊州和芝加哥市公共卫生部门的监测数据库，以确定细菌性性传播疾病（STD）患者中新诊断出的HIV相关风险因素。
将2002年伊利诺伊州公共卫生诊所的衣原体、淋病、早期梅毒（一期、二期和早期潜伏梅毒）及HIV检测结果与患者就诊期间收集的人口统计学和行为调查数据合并。STD定义为任何非HIV阳性检测结果。
在43517次患者就诊中，5814例（13.4%）STD检测结果呈阳性。有308例（0.7%）HIV新检测结果呈阳性，其中71例（23.1%）同时感染了STD。与STD阳性、HIV阴性病例相比，年龄>30岁（比值比[OR]=1.9，95%置信区间[CI]，1.0 - 4.4）、男男性行为者（MSM）（OR = 22.2，95% CI 11.3 - 43.7）和双性恋男性（OR = 22.4，95% CI 7.8 - 64.8）与STD和HIV合并感染独立相关。在不同的STD中，梅毒（n = 438）最为少见（7.5%），但在所有新诊断出的HIV感染中报告比例最高（10.1%），且新诊断出HIV的风险最大（OR = 11.0，95% CI 7.7 - 15.8）。
MSM合并感染STD时新诊断出HIV的风险增加。同时感染STD和HIV的患者比构成STD病例最大比例的美国总体人群年龄更大。这些结果突出了梅毒在HIV传播高危人群中的特殊作用。在STD和HIV共同传播的高危网络中，迫切需要针对MSM和老年人采取有效的检测和预防策略的公共卫生干预措施。
