Risk factors for HIV seroconversion in patients repeatedly HIV tested at a New Orleans sexually transmitted disease clinic, 1990--1998
Description
Since early in the HIV epidemic, a wide variety of studies have provided evidence linking HIV infection with other sexually transmitted diseases. Both the number of studies performed and the consistency of the observed associations suggest that ulcerative and perhaps non-ulcerative STD facilitate HIV transmission. Relatively few well-designed studies have demonstrated these associations in US populations, particularly in predominantly heterosexual populations. This investigation examined behavioral and biological risk factors for HIV seroconversion in patients attending a New Orleans STD clinic between January 1990 and April 1998. A retrospective cohort was constructed using computerized medical records containing client demographics, STD diagnosis information and behavioral risk information. Multivariate Cox regression analysis was used to identify risk factors for HIV seroconversion among clients repeatedly HIV tested, while controlling for the effects of behavioral risks. STD exposure status was permitted to change over the follow-up period, allowing the effect of the timing of STD in relation to HIV seroconversion to be examined. In overall multivariate models, having a recent syphilis or GUD diagnosis was associated with roughly four and five-fold increases in risk of seroconversion in males and females, respectively. Among males with no history of GUD or syphilis, a recent gonorrhea diagnosis was associated with more than a two-fold increase of risk of seroconversion. Among males with a history of GUD or syphilis, those with recent ulcerative STD diagnoses were twice as likely to seroconvert than those with no recent diagnosis. This study suggests that both ulcerative and non-ulcerative STD may be associated with increased risk of HIV transmission and therefore that comprehensive STD control programs may be particularly effective tools for HIV prevention