Exploring the relationship between sexually transmitted diseases and HIV acquisition by using different study designs.
Open accessAbstract
BACKGROUND: It is hypothesized that sexually transmitted diseases (STDs) increase the risk of HIV acquisition. Yet difficulties establishing an accurate temporal relation and controlling confounders have obscured this relationship. In an attempt to overcome prior methodologic shortcomings, we explored the use of different study designs to examine the relationship between STDs and HIV acquisition. METHODS: Acutely HIV-infected patients were included as cases and compared with (1) HIV-uninfected patients (matched case-control), (2) newly diagnosed chronically HIV-infected patients (infected analysis), and (3) themselves at prior clinic visits when they tested HIV negative (case crossover).We used t tests to compare the average number of STDs and logistic regression to determine independent correlates and the odds of acute HIV infection. RESULTS: Between October 2003 and March 2007, 13,662 male patients who had sex with men were tested for HIV infection at San Francisco's municipal STD clinic and 350 HIV infections (2.56%) were diagnosed. Among the HIV-infected patients, 36 cases (10.3%) were identified as acute. We found consistently higher odds of having had an STD within the 12 months [matched case-control, odds ratio 5.2 (2.2-12.6); infected analysis, odds ratio 1.4 (1.0-2.0); and case crossover, odds ratio 1.3 (0.5-3.1)] and 3 months [matched case- control, odds ratio 34.5 (4.1-291.3); infected analysis, odds ratio 2.3 (1.1-4.8); and case crossover, odds ratio 1.8 (0.6-5.6)] before HIV testing among acutely HIV-infected patients.We found higher odds of acute HIV infection among patients with concurrent rectal gonorrhea [17.0 (2.6-111.4), P < 0.01] or syphilis [5.8 (1.1-32.3), P = 0.04] when compared with those HIV-uninfected patients. CONCLUSIONS: Acute HIV infection was associated with a recent or concurrent STD, particularly rectal gonorrhea, among men at San Francisco's municipal STD clinic. Given the complex relationship between STDs and HIV infection, no single design will appropriately control for all the possible confounders; studies using complementary designs are required.
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Similar to other STIs, multiple partners, anonymous partners, condomless sex, and substance use are all associated with HIV infection.
“Similar to other STIs, multiple partners, anonymous partners, condomless sex, and substance use are all associated with HIV infection (193–196).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [195]
In Results, the matched case-control analysis found no difference in the number of partners between acutely HIV-infected patients and HIV-negative controls, contrary to the claim about multiple partners. Methods (Statistical analyses) says comprehensive data on sexual behaviors and substance use were unavailable; the paper does not establish the claimed associations for anonymous partners, condomless sex, or substance use. Page numbers are not available in our copy. (LLM, conf=0.85)
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Cites
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- Authors
- Zetola, N. M., Bernstein, K. T., Wong, E., Louie, B., & Klausner, J. D.
- Affiliations
- University of California, San Francisco (US)
- San Francisco Department of Public Health (US)
- Corresponding author
- Zetola, Nicola M
- Klausner, Jeffrey D
- Venue
- JAIDS Journal of Acquired Immune Deficiency Syndromes
- Published
- 2009-04
- Volume
- 50
- Issue
- 5
- Pages
- 546-551
- ISSN
- 1525-4135 (ISSN-L)
- PMC
- PMC2680242
- OpenAlex
- W1998542753
- Cited by
- 83
- References
- 13
- Citations by year
- 2025: 3 · 2024: 6 · 2023: 5 · 2022: 1 · 2021: 8 · 2020: 5 · 2019: 4 · 2018: 6 · 2017: 5 · 2016: 8 · 2015: 7 · 2014: 4 · 2013: 5 · 2012: 2
- FWCI
- 3.67
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAIDS Journal of Acquired Immune Deficiency Syndromes (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (2m01rr000083-41)
- National Institute of Allergy and Infectious Diseases (T32AI007641)
- National Center for Research Resources (M01-RR000083, RR 00083)
- Topics
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
- Life Sciences › Immunology and Microbiology › Virology › HIV Research and Treatment
- Keywords
- sexually transmitted infections, HIV acquisition, acute HIV infection, rectal gonorrhea, syphilis, men who have sex with men, STD clinic patients, case-control study, case-crossover design, temporal association, confounding adjustment, HIV prevention strategies, HIV prevention funding, HIV prevention education, HIV prevention services
- MeSH terms
- Acute Disease, Chronic Disease, Gonorrhea, Humans, Male, Retrospective Studies, San Francisco, Sexually Transmitted Diseases, Syphilis, HIV Infections, Case-Control Studies, Homosexuality, Male
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