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HIV Incidence among Men Who Have Sex with Men Following Diagnosis with Sexually Transmitted Infections
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    Men who have sex with men (MSM) are at high risk of acquiring HIV infection following diagnosis with other sexually transmitted infections (STIs). Identifying the STIs associated with the greatest risk of subsequent HIV infection could help target prevention interventions, particularly pre-exposure prophylaxis (PrEP).


    Using matched HIV and STI surveillance data from Washington State from 1/1/2007–6/30/2013, we calculated the incidence of new HIV diagnoses following different STI diagnoses among MSM. Men entered observation at the time of their first STI diagnosis during the study period and exited at HIV diagnosis or 6/30/2013. Cox proportional hazards regression was used to conduct a global comparison of rates.


    From 1/1/2007–6/30/2013, 6577 HIV-negative MSM were diagnosed with 10,080 bacterial STIs at 8,371 unique time points and followed for 17,419 person-years. 280 (4.3%) men were subsequently diagnosed with HIV infection for an overall incidence of 1.6 per 100 person-years (95%CI=1.4–1.8). The estimated incidence of HIV diagnoses among all MSM in the state was 0.4 per 100 person-years. MSM were at the greatest risk of HIV diagnosis after being diagnosed with rectal gonorrhea (HIV incidence = 4.1 per 100 person-years), followed by early syphilis (2.8), urethral gonorrhea (1.6), rectal chlamydial infection (1.6), pharyngeal gonorrhea (1.1), late syphilis (1.0), and urethral chlamydial infection (0.6) [p<0.0001 overall].


    MSM diagnosed with rectal gonorrhea and early syphilis were at the greatest risk of being diagnosed with HIV infection post-STI diagnosis. These men should be prioritized for more intensive prevention interventions, including PrEP.

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    PS12-1201/PS/NCHHSTP CDC HHS/United States
    H25 PS004364/PS/NCHHSTP CDC HHS/United States
    P30AI027757/AI/NIAID NIH HHS/United States
    U62 PS003666/PS/NCHHSTP CDC HHS/United States
    P30 AI027757/AI/NIAID NIH HHS/United States
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