Rates of New Human Immunodeficiency Virus (HIV) Diagnoses After Reported Sexually Transmitted Infection in Women in Louisiana, 2000-2015: Implications for HIV Prevention
Rates of New Human Immunodeficiency Virus (HIV) Diagnoses After Reported Sexually Transmitted Infection in Women in Louisiana, 2000-2015: Implications for HIV Prevention
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DOI：
10.1093/cid/ciz303
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发表时间：
2020-03-15
影响因子：
11.8
通讯作者：
Peterman, Thomas A.
中科院分区：
文献类型：
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作者：
Newman, Daniel R.;Rahman, Mohammad M.;Peterman, Thomas A.
背景：针对女性的人类免疫缺陷病毒（HIV）预防干预措施包括筛查、伴侣通知、推广避孕套和暴露前预防（PrEP）。妇女感染艾滋病毒的风险可以帮助指导建议。方法：我们使用路易斯安那州性传播感染（STI）和HIV登记处的数据，研究2000-2015年间首次诊断为梅毒、淋病或衣原体的13至59岁女性。我们测量了性传播感染后（到2016年）报告的艾滋病毒感染率。通过从报告病例和人口普查估计值中减去患有性传播感染的妇女来估计无性传播感染的妇女比率。PrEP费用估计为每年1.1万美元，有效性估计为100%。结果性传播感染主要为梅毒（6574例）、淋病（64 995例）、衣原体（140 034例）。这211603名妇女随访了1865488人年，诊断出969例HIV。没有性传播感染的妇女在24 359 397人/年期间确诊了5186例艾滋病毒。感染过梅毒（177.3）、淋病（73.2）或衣原体感染（35.4）的妇女的HIV诊断率（每10万人年）高于未感染性病的妇女（22.4）。向所有被诊断患有梅毒或淋病的妇女提供预防措施将花费7 371 11.1万美元，并可预防546例艾滋病毒诊断。将PrEP限制在梅毒或淋病诊断后1年内将花费963 847 334美元，但只有143人在梅毒或淋病诊断后2年内诊断出HIV。结论女性性传播感染后的HIV诊断率较高，但不足以使PrEP具有成本效益。大多数被诊断为艾滋病毒的妇女以前没有报告过性传播感染。
Background Human immunodeficiency virus (HIV) prevention interventions for prevention interventions for women include screening, partner notification, promoting condoms, and preexposure prophylaxis (PrEP). Women's risk of acquiring HIV can help guide recommendations.Methods We used data from Louisiana's sexually transmitted infection (STI) and HIV registries to study 13- to 59-year-old women following first diagnosis of syphilis, gonorrhea, or chlamydia during 2000-2015. We measured HIV rates reported subsequent to STI (through 2016). Rates for women without STI were estimated by subtracting women with STI from reported cases and from Census estimates for the population. PrEP cost was estimated as $11 000 per year, and effectiveness estimated as 100%.Results STIs were syphilis (6574), gonorrhea (64 995), or chlamydia (140 034). These 211 603 women had 1 865 488 person-years of follow-up and 969 HIV diagnoses. Women with no STI had 5186 HIV diagnoses over 24 359 397 person-years. HIV rates diagnosis (per 100 000 person-years) were higher for women after syphilis (177.3), gonorrhea (73.2), or chlamydia (35.4) compared to women with no STI (22.4). Providing PrEP to all women diagnosed with syphilis or gonorrhea would cost $7 371 111 000 and could have prevented 546 HIV diagnoses. Limiting PrEP to 1 year after syphilis or gonorrhea diagnosis would cost $963 847 334, but only 143 HIV diagnoses were within 2 years after a syphilis or gonorrhea diagnosis.Conclusions Rates of HIV diagnosis were high after women had STI, but not high enough to make PrEP cost-effective for them. Most women diagnosed with HIV did not have previously reported STI.