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Original research
Sexually transmitted infections in persons living with HIV infection and estimated HIV transmission risk: trends over time from the DC Cohort
  1. Alessandra Anna Secco1,2,
  2. Hana Akselrod1,
  3. Jonathan Czeresnia3,
  4. Matthew Levy4,
  5. Morgan Byrne4,
  6. Anne Monroe4,
  7. Jose Lucar5,
  8. Michael Horberg6,
  9. Amanda Derryck Castel4,
  10. Rupali Doshi4,7,
  11. Heather Rivasplata2,
  12. Leah Squires2,8,
  13. David Parenti1,
  14. Debra Benator1,2
  15. on behalf of the DC Cohort Executive Committee
    1. 1 Infectious Diseases, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
    2. 2 Infectious Diseases Section, DC VA Medical Center, Washington, District of Columbia, USA
    3. 3 Internal Medicine, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
    4. 4 Department of Epidemiology and Biostatistics, George Washington University Milken Institute of Public Health, Washington, District of Columbia, USA
    5. 5 Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, Mississippi, USA
    6. 6 Department of Infectious Diseases, Mid-Atlantic Permanente Medical Group, Rockville, Maryland, USA
    7. 7 HIV/AIDS, Hepatitis, STD, and TB Administration, District of Columbia Department of Health, Washington, District of Columbia, USA
    8. 8 Department of Psychology, DC VA Medical Center, Washington, District of Columbia, USA
    1. Correspondence to Dr Alessandra Anna Secco, Infectious Diseases, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA; allisecco{at}


    Objective A rise in incidence of STIs has been noted in the USA and in the District of Columbia (DC). We aim to describe changes in incident STIs among persons in care for HIV in Washington, DC as well as trends in HIV viral load among those with incident STIs.

    Methods We conducted a retrospective DC Cohort analysis (n=7810) measuring STI incidence (syphilis, gonorrhoea and chlamydia) as well as incare viral load (ICVL) and percentage with all viral loads less than the limit of detection (%<LLOD) by year (2012–2016) among those with incident STIs.

    Results From 2012 to 2016, the incidence of STIs increased: chlamydia from 2.1 to 3.4 cases/100 person-years (p=0.0006), gonorrhoea from 2.1 to 4.0 (p<0.0001), syphilis from 1.7 to 2.6 (p=0.0042) and any STI episode from 5.3 to 8.8 (p<0.0001). STI incidence rates increased for those aged 18–34 (from 13.2 to 23.2 cases/100 person-years, p<0.0001), cisgender men (from 6.5 to 11.5, p<0.0001), non-Hispanic whites (from 8.6 to 16.1, p=0.0003) and men who have sex with men (from 9.3 to 15.7, p<0.0001). During 2012–2016, the ICVL among those with incident STIs improved from 108 to 19 copies/mL and %<LLOD from 23.6% to 55.1%. However, even in 2016, younger participants, cisgender and transgender women, non-Hispanic blacks and Hispanics had higher ICVLs and lower %<LLOD.

    Conclusions Rates of incident STIs rose among persons in care for HIV in Washington, DC, with improved but not optimal measures of HIV viral suppression. These findings inform focused interventions towards preventing STI transmission and ending the HIV epidemic.

    • HIV
    • sexually transmitted infection
    • incidence
    • chlamydia
    • gonorrhoea
    • syphilis

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    • Handling editor Claudia S Estcourt

    • Presented at Portions of this analysis were presented during IDWeek’s Poster Abstract Session on 5 October 2018, under the title 'Sexually Transmitted Infections among Persons Living with HIV Infection and Receiving Care in the District of Columbia: Time with Viral Load above 1500 as Proxy for Risk of Transmission' (Poster No 1498), and at CROI in March 2019, under the title 'Incident STIs among PLWH in Washington, DC: Measuring HIV transmission risk' (Poster No 849).

    • Collaborators Data in this manuscript were collected by the DC Cohort Executive Committee with investigators and research staff located at Cerner Corporation (Jeffery Binkley, Rob Taylor, Nabil Rayeed, Cheryl Akridge, Stacey Purinton, Qingjiang Hou, Jeff Naughton, David Parfitt); Children's National Medical Center Adolescent (Lawrence D'Angelo) and Pediatric (Natella Rahkmanina) clinics; the Senior Deputy Director of the DC Department of Health HIV/AIDS, Hepatitis, STD and TB Administration (Michael Kharfen); Family and Medical Counseling Service (Michael Serlin); Georgetown University (Princy Kumar); The George Washington University Medical Faculty Associates (David Parenti); The George Washington University Department of Epidemiology and Biostatistics (Alan Greenberg, Maria Jaurretche, Brittany Wilbourn, James Peterson, Morgan Byrne, Yan Ma); Howard University Adult Infectious Disease Clinic (Ronald Wilcox) and Pediatric Clinic (Sohail Rana); La Clinica Del Pueblo (Ricardo Fernandez); MetroHealth (Annick Hebou); National Institutes of Health (Carl Dieffenbach, Henry Masur); Providence Hospital (Jose Bordon); Unity Health Care (Gebeyehu Teferi); Washington Hospital Center (Maria Elena Ruiz); and Whitman-Walker Health (Deborah Goldstein).

    • Contributors AAS, HA, ML, MB, AM, JL, MH, ADC, RD and DB were involved in the development of the DC Cohort concept. AAS, HA, JC, ML, MB and DB collaborated on writing of the manuscript. ML and MB provided biostatistical support and data analysis. All authors provided substantive input to interpretation of the analysis findings and review and editing of the manuscript, figures and tables. AM, ADC and the DC Cohort Executive Committee are responsible for the conduct of the DC Cohort study.

    • Funding The DC Cohort is funded by the National Institute of Allergy and Infectious Diseases, UO1 AI69503-03S2. This research was supported by the District of Columbia Center for AIDS Research, an NIH-funded programme (AI117970), which is supported by the following NIH cofunding and participating institutes and centres: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, FIC, NIGMS, NIDDK and OAR. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The DC Cohort study was approved by the George Washington University Institutional Review Board (IRB approval: #071029), and sites with their own IRB also obtained IRB approval to participate. Participants in the DC Cohort consent to have their demographic and clinical data electronically and manually abstracted from medical records at the participating sites and entered into a centralised database (Discovere; Cerner Corporation, Kansas City, Missouri).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.