Cingolani A, Zona S, Girardi E, Cozzi-Lepri A, Monno L, Quiros Roldan E, Guaraldi G, Antinori A, D'Arminio Monforte A, Marcotullio S
Department of Public Health, Infectious Diseases, Catholic University, Rome, Italy.
Clinic of Infectious Diseases, Univeristy of Modena and Reggio Emilia, Modena, Italy.
HIV Med. 2015 Aug;16(7):412-20. doi: 10.1111/hiv.12226. Epub 2015 May 11.
The aims of this study were to identify temporal trends in the incidence of sexually transmitted diseases (STDs) in a cohort of HIV-infected people and to evaluate factors associated with the risk of a new STD diagnosis.
All HIV-infected patients in the Icona Foundation Study cohort enrolled after 1998 were included in this study. STD incidence rates (IRs) were calculated and stratified by calendar period. Predictors of STDs were identified using a Poisson regression model with sandwich estimates for standard errors.
Data for 9168 participants were analysed [median age 37.3 (range 18-81) years; 74% male; 30% men who have sex with men (MSM)]. Over 46 736 person-years of follow-up (PYFU), 996 episodes of STDs were observed [crude IR 21.3/1000 PYFU; 95% confidence interval (CI) 20.0-22.6/1000 PYFU]. In multivariable Poisson regression analysis, MSM [rate ratio (RR) 3.03; 95% CI 2.52-3.64 versus heterosexuals], calendar period (RR 1.67; 95% CI 1.42-1.97 for 2008-2012 versus 1998-2002), HIV RNA > 50 HIV-1 RNA copies/mL (RR 1.44; 95% CI 1.19-1.74 versus HIV RNA ≤ 50 copies/mL) and a current CD4 count < 100 cells/μL (RR 4.66; 95% CI 3.69-5.89; P < 0.001 versus CD4 count > 500 cells/μL) were associated with an increased risk of STDs. In contrast, older age (RR 0.82 per 10 years older; 95% CI 0.77-0.89) and being currently on ART (RR 0.38; 95% CI 0.33-0.45) compared with being ART-naïve or on a treatment interruption were associated with a lower risk of developing STDs.
An increase in the incidence of STDs was observed in more recent years. Interventions to prevent STDs and potential spread of HIV should target the younger population, MSM and people currently not receiving ART.
本研究旨在确定一组艾滋病毒感染者中性传播疾病（STD）发病率的时间趋势，并评估与新发性传播疾病诊断风险相关的因素。
纳入伊科纳基金会研究队列中1998年后入组的所有艾滋病毒感染患者。计算性传播疾病发病率（IR），并按日历时间段进行分层。使用带有标准误差夹心法估计的泊松回归模型确定性传播疾病的预测因素。
分析了9168名参与者的数据[中位年龄37.3岁（范围18 - 81岁）；74%为男性；30%为男男性行为者（MSM）]。在超过46736人年的随访（PYFU）中，观察到996例性传播疾病发作[粗发病率21.3/1000人年；95%置信区间（CI）20.0 - 22.6/1000人年]。在多变量泊松回归分析中，男男性行为者[率比（RR）3.03；95% CI 2.52 - 3.64，与异性恋者相比]、日历时间段（2008 - 2012年与1998 - 2002年相比，RR 1.67；95% CI 1.42 - 1.97）、HIV RNA＞50 HIV - 1 RNA拷贝/mL（RR 1.44；95% CI 1.19 - 1.74，与HIV RNA≤50拷贝/mL相比）以及当前CD4细胞计数＜100个/μL（RR 4.66；95% CI 3.69 - 5.89；与CD4细胞计数＞500个/μL相比，P＜0.001）与性传播疾病风险增加相关。相比之下，年龄较大（每大10岁RR 0.82；95% CI 0.77 - 0.89）以及目前正在接受抗逆转录病毒治疗（ART）（RR 0.38；95% CI 0.33 - 0.45）与未接受抗逆转录病毒治疗或处于治疗中断状态相比，发生性传播疾病的风险较低。
近年来观察到性传播疾病发病率有所上升。预防性传播疾病和艾滋病毒潜在传播的干预措施应针对年轻人群、男男性行为者以及目前未接受抗逆转录病毒治疗的人群。
