title: Sexually Transmitted Infections in Youth With Controlled and Uncontrolled Human Immunodeficiency Virus Infection.
abstract: BACKGROUND
  Sexually transmitted infections (STIs), including human immunodeficiency virus (HIV), disproportionately affect adolescents and young adults (AYAs) ages 13-24 years. Sexually transmitted infections likewise are a risk factor for HIV acquisition and transmission; however, there is a lack of data on STI acquisition in HIV-infected AYAs.
  
  
  METHODS
  We determined the incidence of STIs in HIV-infected AYAs 12.5 <25 years of age in the International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) P1074 observational cohort study. Univariate and multivariable logistic regression models were used to evaluate the association of HIV control (mean viral load <500 copies/mL and CD4+ T cells >500 cells/mm3 in the year preceding STI diagnosis) and other risk factors with STI occurrence.
  
  
  RESULTS
  Of 1201 enrolled subjects, 1042 participants met age criteria and were included (49% male, 61% black, 88% perinatally infected; mean age 18.3 years). One hundred twenty participants had at least 1 STI on study, of whom 93 had their first lifetime STI (incidence rate = 2.8/100 person-years). For individual STI categories, 155 incident category-specific events were reported; human papillomavirus (HPV) and chlamydial infections were the most common. In the multivariable model, having an STI was associated with older age (adjusted odds ratio [aOR] = 1.13; 95% confidence interval [CI], 1.05-1.22), female sex (aOR = 2.65; 95% CI, 1.67-4.21), nonperinatal HIV acquisition (aOR = 2.33; 95% CI, 1.29-4.22), and uncontrolled HIV infection (aOR = 2.05; 95% CI, 1.29-3.25).
  
  
  CONCLUSIONS
  Sexually transmitted infection acquisition in HIV-infected AYAs is associated with older age, female sex, nonperinatal HIV acquisition, and poorly controlled HIV infection. Substantial rates of STIs among HIV-infected AYAs support enhanced preventive interventions, including safe-sex practices and HPV vaccination, and antiretroviral adherence strategies.
authors.affiliation: Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Division of Pediatric Infectious Diseases.|Ponce Family and Youth Clinic, Grady Infectious Diseases Program, Grady Health Systems, Atlanta, Georgia.
authors.forename: Andres F
authors.initials: AF
authors.lastname: Camacho-Gonzalez
authors.affiliation: Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Miriam C
authors.initials: MC
authors.lastname: Chernoff
authors.affiliation: Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Paige L
authors.initials: PL
authors.lastname: Williams
authors.affiliation: Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Division of Pediatric Infectious Diseases.|Ponce Family and Youth Clinic, Grady Infectious Diseases Program, Grady Health Systems, Atlanta, Georgia.
authors.forename: Ann
authors.initials: A
authors.lastname: Chahroudi
authors.affiliation: Department of Pediatrics, Division of Allergy, Immunology, Infectious Diseases and Pulmonology, Rutgers New Jersey Medical School, Newark.
authors.forename: James M
authors.initials: JM
authors.lastname: Oleske
authors.affiliation: Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Shirley
authors.initials: S
authors.lastname: Traite
authors.affiliation: Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Division of Pediatric Infectious Diseases.|Ponce Family and Youth Clinic, Grady Infectious Diseases Program, Grady Health Systems, Atlanta, Georgia.
authors.forename: Rana
authors.initials: R
authors.lastname: Chakraborty
authors.affiliation: Department of Pediatrics, Division of Pediatric Infectious Diseases, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, New York.
authors.forename: Murli U
authors.initials: MU
authors.lastname: Purswani
authors.affiliation: Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Division of Pediatric Infectious Diseases, Aurora.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Abzug
mesh_terms: D000293:Adolescent; D000367:Age Factors; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes; D002694:Chlamydiaceae Infections / Q000150:complications / Q000453:epidemiology / Q000635:transmission; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D030361:Papillomavirus Infections / Q000150:complications / Q000453:epidemiology / Q000635:transmission; D053918:Papillomavirus Vaccines; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission*; D014481:United States / Q000453:epidemiology; D014611:Vaccination; D019562:Viral Load; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines
keywords: HIV; adolescents; sexually transmitted infections