The Estimated Number and Lifetime Medical Cost of HIV Infections Attributable to Sexually Transmitted Infections Acquired in the United States in 2018: A Compilation of Published Modeling Results

Abstract

Background: The purpose of this study was to estimate the number and lifetime medical cost of HIV infections attributable to incident sexually transmitted infections (STIs) in the United States in 2018.

Methods: We combined data from published models regarding the number or percentage of HIV infections attributable to STIs with updated estimates of the lifetime medical cost per HIV infection. We used 2 distinct calculation methods. Our first calculation used recent estimates of the percentage of HIV infections in men who have sex with men (MSM) attributable to gonorrhea and chlamydia. Our second calculation, based on older studies, used estimates of the expected number of STI-attributable HIV infections per new STI infection, for gonorrhea, chlamydia, syphilis, and trichomoniasis.

Results: Our first calculation method suggested that 2489 (25th-75th percentiles, 1895-3000) HIV infections in 2018 among MSM could be attributed to gonorrhea and chlamydia, at an estimated lifetime medical cost of $1.05 billion (25th-75th percentiles, $0.79-$1.26 billion). Our second calculation method suggested that 2349 (25th-75th percentiles, 1948-2744) HIV infections in the general population (including MSM) could be attributed to chlamydia, gonorrhea, syphilis, and trichomoniasis acquired in 2018, at an estimated lifetime medical cost of $0.99 billion (25th-75th percentiles, $0.80-$1.16 billion).

Conclusions: Despite ambiguity regarding the degree to which STIs affect HIV transmission, our combination of data from published STI/HIV transmission models and an HIV lifetime medical cost model can help to quantify the estimated burden of STI-attributable HIV infections in the United States.

Figure 1. Tornado diagram showing results of the one-way sensitivity analyses of the estimated lifetime medical cost of HIV infections attributable to STIs acquired in 2018 for calculation method 1 (top) and calculation method 2 (bottom)

This diagram shows how the estimated lifetime medical cost of HIV infections attributable to STIs acquired in 2018 changed from the base case result of $1.05 billion (calculation method 1) and $0.99 billion (calculation method 2) when one parameter value was varied at a time and all other parameters were kept at their base case values. For example, for calculation method 1, the estimated cost of STI-attributable HIV infections varied from $0.47 billion to $1.82 billion when the percent of HIV infections attributable to gonorrhea and chlamydia was varied from its 2.5^th percentile value of 4.6% to its 97.5^th percentile value of 17.7%. For calculation method 2, when an STI-specific parameter value was varied, it was varied for all four STIs (e.g., when varying the number of incident STIs in 2018, we first calculated the cost of HIV infections attributable to STIs acquired in 2018 when setting all four STIs to their respective lower bound incidence values, and then when setting all four STIs to their respective upper bound incidence values).