Seroconversion in patients attending sexually transmitted disease clinics.
OBJECTIVE
To characterize recent HIV seroconverters in a sexually transmitted disease (STD) clinic population, and examine changing transmission patterns.


METHODS
We conducted a case-control study nested within a retrospectively defined cohort of individuals attending Baltimore STD clinics between January 1988 and July 1990. Seroconverters, who tested HIV-positive after having a negative test, were compared to both HIV-negative controls, who were also tested twice, and a second, prevalent HIV-positive control group. Controls were matched 2:1 by sex, clinic, and month of HIV test.


RESULTS
Forty-nine out of 6175 (0.79%) patients tested at least twice had documented HIV-1 seroconversion. On multivariate analysis, seroconversion was significantly associated with self-reported injecting drug use [odds ratio (OR), 7.3; 95% confidence interval (CI), 2.3-23)], with being a man who has had sex with other men (OR, 3.5%; 95% CI, 1.2-10), or with having sex with a known HIV-infected person (OR, 11; 95% CI, 1.3-96). Thirty-five per cent of seroconverters did not report a risk for HIV infection, and a higher proportion of recent seroconverters also reported no risk. Compared to the prevalent positive control group, more seroconverters reported no risk and a lower proportion reported recognized risks. A diagnosis of gonorrhea was also significantly associated with seroconversion (OR, 2.5; 95% CI, 1.1-5.7).


CONCLUSIONS
These data suggest increasing heterosexual transmission of HIV in this inner-city STD clinic population. Incident STD, in particular gonorrhea, may increase a patient's risk for HIV infection, suggesting that patients with STD should be targeted aggressively for HIV prevention activities.
Division of STD/HIV Prevention, Centers for Disease Control, Atlanta, GA 30333.
W J
WJ
Kassler
J M
JM
Zenilman
B
B
Erickson
R
R
Fox
T A
TA
Peterman
E W
EW
Hook
D000328:Adult; D000554:Ambulatory Care Facilities; D015142:Baltimore / Q000453:epidemiology; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006069:Gonorrhea / Q000150:complications; D015658:HIV Infections / Q000517:prevention & control / Q000635:transmission; D006679:HIV Seropositivity / Q000150:complications* / Q000453:epidemiology*; D015497:HIV-1; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012749:Sexually Transmitted Diseases / Q000150:complications*; D015819:Substance Abuse, Intravenous / Q000150:complications