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007.4 Incident hiv associated with rectal gonorrhoea (gc) and chlamydia (ct) independent of sexual behaviour in men who have sex with men (msm)
  1. LA Barbee1,2,
  2. CM Khosropour1,
  3. JC Dombrowski1,2,
  4. MR Golden1,2
  1. 1University of Washington
  2. 2Public Health – Seattle & King County


Introduction Although STIs are associated with HIV-acquisition, because they share a causal pathway – sex – how much this risk is independent of sexual behaviour remains unknown.

Methods We conducted a case-control study of MSM STD clinic patients in Seattle, WA, 2001–2014 to evaluate the role of concurrent and prior rectal STIs in HIV-acquisition. Cases were new HIV diagnoses who tested HIV-negative ≤12 months prior. Controls tested HIV-negative and were matched to cases on year. All included men tested for rectal STI and tested negative for syphilis. We used routinely collected condom-use data to create four sexual behaviour categories: no receptive anal intercourse (RAI) in ≤12 months, consistent condom-use for all RAI, condomless RAI only with HIV-negative partners (CRAIneg), and CRAI with HIV-positive/unknown-status partners (CRAIpos/unk). We used logistic regression to estimate odds ratios (OR) of the association between rectal GC/CT and HIV diagnosis.

Results Among 176 cases and 704 controls, concurrent rectal GC (OR3.5 95% CI 2.3–5.5) and rectal CT (OR3.2 95% CI 2.1–5.1) were associated with HIV diagnosis in univariate analysis. Controlling for age, race, number of sex partners, methamphetamine use year and other rectal STI, both rectal GC (aOR2.4 95% CI 1.4–4.0) and CT (aOR2.6 95% CI 1.5–4.4) continued to be associated with HIV diagnosis. Adding sexual behaviours to the model did not change the association between rectal infection and HIV diagnosis (GC aOR2.3, 95% CI 1.4–3.9; CT aOR 2.6 95% CI 1.5–4.3). CRAIneg (aOR3.5 95% CI 1.2–10.4) and CRAIpos/ukn (aOR4.2 95% CI 1.4–12.5) were independently associated with new HIV diagnosis. Rectal  infection in ≤12 months was strongly associated with new HIV diagnosis (aOR3.4 95% CI 1.5–7.4).

Conclusions Concurrent and prior rectal GC/CT are associated with HIV-acquisition independent of sexual behaviour, suggesting a causal role for rectal STI in HIV-acquisition, and supporting STI control as an HIV-prevention strategy.

Disclosure of interest statement This work was funded by the US National Institutes of Health. No pharmaceutical grants were received in the development of this study.

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