HIV diagnoses frequent among MSM attending STD clinics

Issue: January 2016

ATLANTA — HIV diagnoses are common among men who have sex with men seeking care at local STD clinics and occur more frequently in those also diagnosed with an STD infection, according to surveillance data presented at the CDC’s National HIV Prevention Conference.

These findings support greater efforts to promote HIV prevention strategies to MSM with and without HIV who attend these clinics, according to Eloisa L. Llata, MD, MPH, of the CDC.

Surveillance data suggest high incidence of HIV/STD coinfection

“In many U.S. jurisdictions, a substantial portion of reported HIV, in addition to STDs, have been diagnosed in an STD clinic, making them an important health care setting for at-risk populations,” Llata said during a presentation. “Findings from previous studies of MSM attending STD clinics have demonstrated that certain STDs may serve as objective markers for identifying persons at extremely high risk for HIV.”

Using 2010-2013 data from the STD Surveillance Network (SSuN), Llata and colleagues examined the diagnoses of MSM attending one of 41 participating STD clinics across the United States. Eligible participants were required to have at least two HIV tests, the first of which being negative to stagger cohort entry. HIV incidence among this population was calculated as the number of HIV diagnoses over total person-years (PY) since a first negative test. Researchers also examined demographic and STD diagnosis data to determine subgroups with increased HIV burden.

Source:CDC

Among the 14,824 MSM included in the analysis, Llata and colleagues observed 640 HIV diagnoses over 20,951.6 PY. This translated to a national incidence rate of 3.1 diagnoses per 100 PY (95% CI, 2.9-3.3), but were as low as 0.7 per 100 PY and as high as 8.2 per 100 PY for individual SSuN jurisdiction areas. Diagnoses were most common among MSM aged 19 years or younger (6.9 per 100 PY; 95% CI, 4.6-10.4) and MSM who were black (5 per 100 PY; 95% CI, 4.4-5.6). MSM diagnosed with an STD also were more often coinfected with HIV (3.5 per 100 PY vs. 2.7 per 100 PY), particularly if diagnoses with primary and secondary syphilis (5.7 per 100 PY), rectal gonorrhea (3.9 per 100 PY) or chlamydia (3.6 per 100 PY).

“Greater efforts are needed to ascertain HIV status and/or perform HIV testing in these facilities,” Llata said. “Given our observed 3.1 per 100 PY rate of all MSM attending STD clinics, this certainly underscores the need to evaluate and intensify all prevention efforts — not just those with the highest rates — and it should be considered for all HIV-negative MSM attending STD clinics.”

Record high STD rates threaten MSM

These findings follow data from the CDC’s annual STD report indicating that nationally notifiable STD infections were on the rise in 2014.

Surveillance information collected from state and local STD case reports indicated 1,441,789 cases of chlamydia were reported last year to the CDC, which translates to an incidence rate of 456.1 cases per 100,000 population. This represents a 2.8% increase over 2013, according to the CDC, and is the highest annual rate of chlamydia infection ever reported in the U.S. Further, there were 19,999 cases of primary and secondary syphilis, representing a 15.1% annual infection rate increase to 6.3 cases per 100,000 population, and 50,062 reported gonorrhea cases resulting in a 5.1% rate increase to 110.7 cases per 100,000 population.

Although these incidence rates demonstrate the full U.S. population, the findings are especially problematic for MSM. According to the report, MSM accounted for 83% of male syphilis cases in which the sex of an individual’s partners was reported, and 51% of MSM diagnosed with syphilis were coinfected with HIV. Although syphilis is the only nationally notifiable STD in which sex partner information is reported, data collected through the SSuN among MSM tested at participating clinics imply the prevalence of gonorrhea and chlamydia to be 19.2% and 14.9%, respectively. The CDC wrote that this sentinel surveillance system data — along with high-risk behaviors often associated with MSM — suggest chlamydia and gonorrhea infections also may be of significant concern among this population.

Jonathan Mermin

“America’s worsening STD epidemic is a clear call for better diagnosis, treatment and prevention,” Jonathan Mermin, MD, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and Tuberculosis Prevention, said in a press release. “STDs affect people in all walks of life, particularly young women and men, but these data suggest an increasing burden among gay and bisexual men.” – by Dave Muoio

References:

CDC. Sexually Transmitted Disease Surveillance 2014. www.cdc.gov/std/stats14/surv-2014-print.pdf. Accessed December 10, 2015.

Llata EL, et al. Abstract 1598. Presented at: National HIV Prevention Conference; Dec. 6-9, 2015; Atlanta.

Disclosure: The researchers report no relevant financial disclosures.