Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Department of Epidemiology and Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, MA.
Sex Transm Dis. 2022 Mar 1;49(3):223-230. doi: 10.1097/OLQ.0000000000001578.
BACKGROUND: Of new sexually transmitted infections (STIs) in the United States, 50% occur among youth aged 15 to 24 years. Previous studies among youth with HIV (YHIV) do not distinguish STI trends among individuals with perinatally (YPHIV) and nonperinatally (YNPHIV) acquired HIV. METHODS: Among 3 Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) studies conducted between 2009 and 2015, we estimated incident diagnoses of trichomonal, bacterial, viral, and overall STIs stratified by sex assigned at birth, mode of HIV acquisition (perinatal [YPHIV] and nonperinatal [YNPHIV]), age (13-17 and 18-24 years), CD4 count (<200, 200-499, and ≥500/μL), and HIV viral load (VL) (<400 and ≥400 copies/mL). RESULTS: Among 3131 YHIV, across the 3 studies, mean (SD) age was 20.6 (2.6) years, 888 (28%) were female, 2498 (80%) had nonperinatal HIV acquisition recorded, and 2298 (73%) were African American/Black. Mean follow-up was 0.9 (0.3) years. Compared with YPHIV, YNPHIV spent less person-time with VL <400 copies/mL (47% vs. 53%) and more time off antiretroviral therapy (49% vs. 15%), and had higher overall STI rates (males, 65.9 vs. 8.5/100 person-years [PY]; females, 54.7 vs. 17.2/100 PY). Among YPHIV, bacterial STIs were higher during person-time spent with VL ≥400 vs. <400 copies/mL (male YPHIV, 10.9 vs. 0.6/100 PY; female YPHIV, 11.2 vs. 2.9/100 PY); no difference was observed among YNPHIV, which may be due to concurrent acquisition of HIV and other STIs and limited follow-up. CONCLUSIONS: Compared with YPHIV, YNPHIV spent less time on antiretroviral therapy and virologically suppressed; YNPHIV also had higher STI diagnosis rates. Very high STI diagnosis rates among YHIV, including among those without virologic suppression, highlight the importance of youth-focused efforts to support durable virologic suppression and identify and treat STIs.
背景：在美国新发生的性传播感染（STI）中，有 50%发生在 15 至 24 岁的年轻人中。以前针对 HIV 阳性青年（YHIV）的研究并未区分经母体（YPHIV）和非经母体（YNPHIV）获得 HIV 的个体的 STI 趋势。
方法：在 2009 年至 2015 年期间进行的三个青少年医学试验网络艾滋病毒/艾滋病干预措施（ATN）研究中，我们根据出生时的性别分配、HIV 获得方式（经母体[YPHIV]和非经母体[YNPHIV]）、年龄（13-17 岁和 18-24 岁）、CD4 计数（<200、200-499 和≥500/μL）和 HIV 病毒载量（VL）（<400 和≥400 拷贝/mL），对沙眼衣原体、细菌性、病毒性和总体 STI 的新发病例进行了分层估计。
结果：在 3131 名 YHIV 中，在这三项研究中，平均（SD）年龄为 20.6（2.6）岁，888 名（28%）为女性，2498 名（80%）记录了非经母体 HIV 获得，2298 名（73%）为非裔美国人/黑人。平均随访时间为 0.9（0.3）年。与 YPHIV 相比，YNPHIV 花费更少的时间处于 VL<400 拷贝/mL（47%对 53%），更多的时间未接受抗逆转录病毒治疗（49%对 15%），并且总体 STI 发生率更高（男性，65.9 对 8.5/100 人年[PY]；女性，54.7 对 17.2/100 PY）。在 YPHIV 中，VL≥400 与<400 拷贝/mL 时细菌性 STI 更高（男性 YPHIV，10.9 对 0.6/100 PY；女性 YPHIV，11.2 对 2.9/100 PY）；YNPHIV 中未观察到差异，这可能是由于同时获得 HIV 和其他 STI 以及随访时间有限。
结论：与 YPHIV 相比，YNPHIV 接受抗逆转录病毒治疗和病毒学抑制的时间更少；YNPHIV 的 STI 诊断率也更高。YHIV 的 STI 诊断率非常高，包括那些没有病毒学抑制的患者，这突出了以青年为重点的努力的重要性，这些努力旨在支持持久的病毒学抑制，并发现和治疗 STI。
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