High rates of sexually transmissible infections in HIV-positive patients in the Australian HIV Observational Database: a prospective cohort study
Brian P. Mulhall A B O , Stephen Wright A , Debbie Allen C , Katherine Brown B D E , Bridget Dickson F , Miriam Grotowski G , Eva Jackson H , Kathy Petoumenos A , Phillip Read A I , Timothy Read J , Darren Russell K L , David J. Smith M , David J. Templeton A N , Christopher K. Fairley J L and Matthew G. Law A
+ Author Affiliations
- Author Affiliations
A The Kirby Institute for Infection and Immunity in Society, Wallace Wurth Building, University of New South Wales, Sydney, NSW 2052, Australia.
B University of Sydney, Camperdown, NSW 2006, Australia.
C Holden Street Sexual Health Clinic, PO Box 361, Gosford, NSW 2250, Australia.
D Illawarra Sexual Health Services, PO Box 21, Warrawong, NSW 2502, Australia.
E University of Wollongong, Wollongong, NSW 2522, Australia.
F Caradata, PO Box 579, Arundel DC, Qld 4214, Australia.
G Clinic 468, Tamworth Sexual Health, Hunter New England Area Health Service, NSW 2340, Australia.
H Nepean/Blue Mountains Sexual Health, Nepean Hospital, Kingswood NSW 2747, Australia.
I Sydney Sexual Health Centre, PO Box 1614, Sydney, NSW 2001, Australia.
J Melbourne Sexual Health Centre, Alfred Hospital, Prahran, Vic. 3181, Australia.
K Cairns Sexual Health Service, PO Box 902, Cairns, Qld 4214, Australia.
L Melbourne School of Population Health, University of Melbourne, 580 Swanston St, Carlton, Vic 3053, Australia.
M Lismore Sexual Health Services, 4 Shepherd Lane, Lismore, NSW 2480, Australia.
N RPA Sexual Health, 16 Marsden Street, Camperdown, NSW 2050, Australia.
O Corresponding author. Email: brianm@health.usyd.edu.au
Sexual Health 11(4) 291-297 https://doi.org/10.1071/SH13074
Submitted: 12 May 2013 Accepted: 19 May 2014 Published: 11 August 2014
Abstract
Background: In HIV-positive people, sexually transmissible infections (STIs) probably increase the infectiousness of HIV. Methods: In 2010, we established a cohort of individuals (n = 554) from clinics in the Australian HIV Observational Database (AHOD). We calculated retrospective rates for four STIs for 2005–10 and prospective incidence rates for 2010–11. Results: At baseline (2010), patient characteristics were similar to the rest of AHOD. Overall incidence was 12.5 per 100 person-years. Chlamydial infections increased from 3.4 per 100 person-years (95% confidence interval (CI): 1.9–5.7) in 2005 to 6.7 per 100 person-years (95% CI: 4.5–9.5) in 2011, peaking in 2010 (8.1 per 100 person-years; 95% CI: 5.6–11.2). Cases were distributed among rectal (61.9%), urethral (34%) and pharyngeal (6.3%) sites. Gonococcal infections increased, peaking in 2010 (4.7 per 100 person-years; 95% CI: 5.6–11.2; Ptrend = 0.0099), distributed among rectal (63.9%), urethral (27.9%) and pharyngeal (14.8%) sites. Syphilis showed several peaks, the largest in 2008 (5.3 per 100 person-years; 95% CI: 3.3–8.0); the overall trend was not significant (P = 0.113). Genital warts declined from 7.5 per 100 person-years (95% CI: 4.8–11.3) in 2005 to 2.4 per 100 person-years (95% CI: 1.1–4.5) in 2011 (Ptrend = 0.0016). Conclusions: For chlamydial and gonococcal infections, incidence was higher than previous Australian estimates among HIV-infected men who have sex with men, increasing during 2005–2011. Rectal infections outnumbered infections at other sites. Syphilis incidence remained high but did not increase; that of genital warts was lower and decreased.
Additional keywords: anogenital warts, chlamydia, gonorrhoea, human papillomavirus, men, syphilis.
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