title: The association of uncontrolled HIV infection and other sexually transmitted infections in metropolitan Atlanta youth.
abstract: BACKGROUND
  Half of the 19 million sexually transmitted infections (STIs) and 26% of HIV infections annually in the United States occur in youth aged 13-24 years. STIs are a risk factor for HIV acquisition and transmission, but data are lacking on HIV treatment as an intervention to reduce STIs.
  
  
  METHODS
  A single-centered, retrospective analysis of HIV-infected sexually active adolescents and young adults from January 2009 to December 2011 was performed to compare STI incidence among patients with controlled and uncontrolled HIV and to identify associated risk factors.
  
  
  RESULTS
  Of 205 enrolled subjects, 59% were male and 92% African American with mean age of 21 years (2.1 SD). Sixty-six percent were horizontally infected, and 19% met the definition of controlled HIV. Forty-seven percent were men who have sex with men, 76% reported condom use, 27% prior sexual abuse, 58% drug use and 50% claimed >5 lifetime sexual partners. Sixty-seven percent contracted a co-STI for a cumulative incidence rate of 35 STIs per 100 person-years. Subjects with uncontrolled HIV had a significantly higher STI incidence than did subjects with controlled infection (42.7 vs. 19.7 per 100 person-years, P < 0.001). Uncontrolled individuals had more STIs (P = 0.01), sexual partners (P = 0.008) and horizontal acquisition (P = 0.001). In an adjusted logistic model, having ≥1 STI was associated with older age (P = 0.033), >5 sexual partners (6-10 partners, P = 0.001; >10, P < 0.001) and no condom use (P = 0.025). Subjects with uncontrolled infection had 2.8 times [95% confidence interval (CI): 1.16-6.94] the odds of ≥1 STI relative to controlled HIV.
  
  
  CONCLUSIONS
  Uncontrolled HIV increases the incidence of co-STIs among adolescents and young adults. Interventions to improve antiretroviral compliance and reduce risk behaviors are urgently needed.
authors.affiliation: From the *Department of Pediatrics, Children's Healthcare of Atlanta, Georgia; †Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; ‡Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia; §Division of Pediatric Infectious Diseases, Department of Pediatrics, Emory University School of Medicine & Children's Healthcare of Atlanta, Georgia; and ¶Ponce Family and Youth Clinic, Grady Infectious Diseases Program, Grady Health Systems, Atlanta, Georgia.
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Brownstein
authors.forename: Scott E
authors.initials: SE
authors.lastname: Gillespie
authors.forename: Traci
authors.initials: T
authors.lastname: Leong
authors.forename: Ann
authors.initials: A
authors.lastname: Chahroudi
authors.forename: Rana
authors.initials: R
authors.lastname: Chakraborty
authors.forename: Andres F
authors.initials: AF
authors.lastname: Camacho-Gonzalez
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D005260:Female; D005845:Georgia / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology* / Q000635:transmission; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012725:Sexual Behavior / Q000706:statistics & numerical data; D012749:Sexually Transmitted Diseases / Q000150:complications / Q000453:epidemiology* / Q000635:transmission; D055815:Young Adult