Improvements in Virologic Control Among PWH Over Time: Narrowing the Gap Between Those With and Without STIs

Abstract

Using the incidence of bacterial sexually transmitted infection (STI) as a surrogate for condomless sexual behavior, we assessed the association between STI and uncontrolled HIV replication among in-care persons with HIV (PWH) enrolled in a longitudinal HIV cohort study in the District of Columbia (the DC Cohort). Although STI occurrence initially correlated with higher HIV viral load (VL), this difference became more attenuated over time (2012-2016). This was true overall and among those with the greatest number of STIs [age 18-34, men who have sex with men (MSM)]. This likely reflects gains in population-wide virologic control through improved antiretroviral therapy and access to care, which helps mitigate the risk of HIV transmission.

Keywords: Ending the HIV Epidemic; HIV; HIV transmission; Sexually transmitted infection; Viral load.

Figure.

Yearly ICVL of study participants stratified by number of STI occurrences, 2012 – 2016. A) Geometric means and B) percentages are presented as solid light grey line for No STI, dashed medium grey line for 1 STI, and dotted black line for >1 STI. Trends between geometric means were significant for both No and 1 STI groups (p-value = <0.001) as well as >1 STI (p-value=0.0163) Differences between geometric means for all STI groups were significant across all years (p-value = <0.001).