Proportion of Incident HIV Cases among Men Who Have Sex with Men Attributable to Gonorrhea and Chlamydia: A Modeling Analysis

Details

• Alternative Title:
  Sex Transm Dis
• Personal Author:
  Jones, Jeb ; Weiss, Kevin ; Mermin, Jonathan ; Dietz, Patricia ; Rosenberg, Eli S. ; Gift, Thomas L. ; Chesson, Harrell ; Sullivan, Patrick S. ; Lyles, Cynthia ; Bernstein, Kyle T. ; Jenness, Samuel M.
• Description:
  Background
  
  Sexually transmitted infections (STIs) are associated with an increased risk of HIV acquisition and transmission. We estimated the proportion of HIV incidence among men who have sex with men attributable to infection with the two most common bacterial STIs, Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT).
  
  Methods
  
  We used a stochastic, agent-based model of a sexual network of MSM with co-circulating HIV, NG, and CT infections. Relative risk (RR) multipliers, specific to anatomic site of infection, modified the risk of HIV transmission and acquisition based on STI status. We estimated the effect of NG and CT on HIV incidence overall and on HIV acquisition and HIV transmission separately. Each scenario was simulated for ten years. The population attributable fraction (PAF) was determined for each combination of RRs by comparing the incidence in the final year of a scenario to a scenario in which the RRs associated with NG and CT were set to 1.0.
  
  Results
  
  Overall, 10.4% (IQR: 7.9,12.4) of HIV infections were attributable to NG/CT infection. Then in sensitivity analyses, the PAF for HIV transmission ranged from 3.1% (IQR: 0.5, 5.2) to 20.4% (IQR: 17.8, 22.5) and the PAF for HIV acquisition ranged from 2.0% (IQR: −0.7, 4.3) to 13.8% (IQR: 11.7, 16.0).
  
  Conclusions
  
  Despite challenges in estimating the causal impact of NG/CT on HIV risk, modeling is an alternative approach to quantifying plausible ranges of effects given uncertainty in the biological co-factors. Our estimates represent idealized public health interventions in which STI could be maximally prevented, setting targets for real-world STI interventions that seek to reduce HIV incidence.
  
  
• Subjects:
  Chlamydia Infections Gonorrhea HIV Infections Homosexuality, Male Humans Incidence Male Models, Statistical Risk Sexual And Gender Minorities Sexual Behavior United States

  More +
• Source:
  Sex Transm Dis. 46(6):357-363
• Pubmed ID:
  31095100
• Pubmed Central ID:
  PMC6530490
• Document Type:
  Journal Article
• Funding:
  R01 AI138783/AI/NIAID NIH HHSUnited States/ ; P30 AI050409/AI/NIAID NIH HHSUnited States/ ; R01 HD068395/HD/NICHD NIH HHSUnited States/ ; CC999999/ImCDC/Intramural CDC HHSUnited States/ ; U38 PS004646/PS/NCHHSTP CDC HHSUnited States/ ; R21 HD075662/HD/NICHD NIH HHSUnited States/ ; R21 MH112449/MH/NIMH NIH HHSUnited States/ ; R24 HD042828/HD/NICHD NIH HHSUnited States/
• Volume:
  46
• Issue:
  6
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:9df0fa4c3a5a2859917046bda1721661099b04afd39bb5cd359f69e34534eef602ae975d9bab0571147b51767724a7cd5af96eec91a303b350c406ac55dc9edc
• Download URL:
  https://stacks.cdc.gov/view/cdc/79001/cdc_79001_DS1.pdf
• File Type:
  [PDF - 96.52 KB ]