M A J O R A R T I C L EH I V / A I D S
HIV Incidence Among Men With and Those
Without Sexually Transmitted Rectal Infections:
Estimates From Matching Against an HIV Case
Preeti Pathela,1Sarah L. Braunstein,2Susan Blank,1,3and Julia A. Schillinger1,3
1Bureau of Sexually Transmitted Disease Control and2Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental
Hygiene, New York; and3Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
tifying HIV risk among men who have sex with men (MSM) who have had these infections can inform prevention
efforts. We measured HIV risk among MSM who have and those who have not been diagnosed with rectal Chla-
mydia trachomatis (CT) and/or rectal Neisseria gonorrhoeae (GC).
Methods. HIV incidence among a cohort of 276 HIV-negative MSM diagnosed with rectal CT and/or GC in
New York City sexually transmitted disease (STD) clinics was compared to HIV incidence among HIV-negative
MSM without these infections. Matches against the citywide HIV/AIDS registry identified HIV diagnoses from
STD clinics, and by other providers. Cox proportional hazards models were used to explore factors associated with
HIV acquisition among MSM with rectal infections.
Results. HIV-negative MSM with rectal infections (>70% of which were asymptomatic) contributed 464.7
person-years of follow-up. Among them, 31 (11.2%) were diagnosed with HIV, of whom 14 (45%) were diagnosed
by non-STD clinic providers. The annual HIV incidence was significantly higher among MSM with rectal infections
(6.67%; 95% confidence interval [CI], 4.61%–9.35%) than among MSM without rectal infections (2.53%; 95% CI,
1.31%–4.42%). Black race (hazard ratio, 4.98; 95% CI, 1.75–14.17) was associated with incident HIV among MSM
with rectal CT/GC.
Conclusions.One in 15 MSM with rectal infections was diagnosed with HIV within a year, a higher risk than
for MSM without rectal infections. Such data have implications for screening for rectal STD, and may be useful for
targeting populations for risk-reduction counseling and other HIV prevention strategies, such as preexposure pro-
Sexually transmitted bacterial rectal infections are objective markers of HIV risk behavior. Quan-
Keywords.HIV; rectal Chlamydia; rectal gonorrhea; MSM.
In the developed world, human immunodeficiency vi-
rus (HIV) infection disproportionately affects gay men
and other men who have sex with men (MSM) [1,2].In
New York City (NYC), an epicenter of the US HIV/
AIDS epidemic, 48% of the 3481 new HIV/AIDS diag-
noses in 2010 were among MSM . NYC surveillance
data indicate that MSM also have a high burden of bac-
terial sexually transmitted diseases (STDs), such as
Neisseria gonorrhoeae (GC) and syphilis [4, 5]. Biologi-
cal and physiological mechanisms have been proposed
to explain how STDs increase HIV risk [6–8], and nu-
merous studies have suggested that STDs are associated
with an increased risk for HIV acquisition [9–13].
Some STD and HIV surveillance laws prohibit the data
sharing necessary to identify individuals across registries
Received 14 March 2013; accepted 17 June 2013; electronically published 25
Correspondence: Preeti Pathela, DrPH, MPH, Bureau of Sexually Transmitted
Disease Control, New York City Department of Health and Mental Hygiene,
Gotham Center, 42-09 28th St, Queens, New York 11101-4132 (ppathela@health.
Clinical Infectious Diseases2013;57(8):1203–9
© The Author 2013. Published by Oxford University Press on behalf of the Infectious
Diseases Society of America. All rights reserved. For Permissions, please e-mail:
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