title: Incidence and factors associated with the risk of sexually transmitted diseases in HIV-infected people seen for care in Italy: data from the Icona Foundation cohort.
abstract: OBJECTIVE
  The aims of this study were to identify temporal trends in the incidence of sexually transmitted diseases (STDs) in a cohort of HIV-infected people and to evaluate factors associated with the risk of a new STD diagnosis.
  
  
  METHODS
  All HIV-infected patients in the Icona Foundation Study cohort enrolled after 1998 were included in this study. STD incidence rates (IRs) were calculated and stratified by calendar period. Predictors of STDs were identified using a Poisson regression model with sandwich estimates for standard errors.
  
  
  RESULTS
  Data for 9168 participants were analysed [median age 37.3 (range 18-81) years; 74% male; 30% men who have sex with men (MSM)]. Over 46 736 person-years of follow-up (PYFU), 996 episodes of STDs were observed [crude IR 21.3/1000 PYFU; 95% confidence interval (CI) 20.0-22.6/1000 PYFU]. In multivariable Poisson regression analysis, MSM [rate ratio (RR) 3.03; 95% CI 2.52-3.64 versus heterosexuals], calendar period (RR 1.67; 95% CI 1.42-1.97 for 2008-2012 versus 1998-2002), HIV RNA > 50 HIV-1 RNA copies/mL (RR 1.44; 95% CI 1.19-1.74 versus HIV RNA ≤ 50 copies/mL) and a current CD4 count < 100 cells/μL (RR 4.66; 95% CI 3.69-5.89; P < 0.001 versus CD4 count > 500 cells/μL) were associated with an increased risk of STDs. In contrast, older age (RR 0.82 per 10 years older; 95% CI 0.77-0.89) and being currently on ART (RR 0.38; 95% CI 0.33-0.45) compared with being ART-naïve or on a treatment interruption were associated with a lower risk of developing STDs.
  
  
  CONCLUSIONS
  An increase in the incidence of STDs was observed in more recent years. Interventions to prevent STDs and potential spread of HIV should target the younger population, MSM and people currently not receiving ART.
authors.affiliation: Department of Public Health, Infectious Diseases, Catholic University, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Cingolani
authors.affiliation: Clinic of Infectious Diseases, Univeristy of Modena and Reggio Emilia, Modena, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Zona
authors.affiliation: Department of Epidemiology, National Institute for Infectious Diseases 'L. Spallanzani', Rome, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Girardi
authors.affiliation: Department of Infection and Population Health, Division of Population Health, University College London Medical School, Royal Free Campus, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Cozzi-Lepri
authors.affiliation: Institute of Infectious Diseases, University of Bari, Bari, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Monno
authors.affiliation: Institute of Infectious Diseases, University of Brescia, Brescia, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Quiros Roldan
authors.affiliation: Clinic of Infectious Diseases, Univeristy of Modena and Reggio Emilia, Modena, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Guaraldi
authors.affiliation: Clinical Department, National Institute for Infectious Diseases 'L. Spallanzani', Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Antinori
authors.affiliation: Clinic of Infectious and Tropical Diseases, Department of Health Sciences, San Paolo University Hospital, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: D'Arminio Monforte
authors.affiliation: Nadir Foundation Onlus, Rome, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Marcotullio
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D018791:CD4 Lymphocyte Count; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology* / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012725:Sexual Behavior / Q000523:psychology / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000517:prevention & control / Q000523:psychology / Q000635:transmission*; D019562:Viral Load
keywords: HIV; cohort; incidence; sexually transmitted diseases