Poorly Controlled HIV in Adolescents Related to Increased Risk of Other STIs

Adolescents infected with HIV tend to have sex with more frequency and to be at increased risk for other sexually transmitted infections, according to a research panel presented at the 2017 Annual Pediatric Academic Societies Meeting (PASM) in San Francisco, California, from May 6-9, 2017. The panel of researchers included Andres Camacho-Gonzalez, MD, a pediatric infectious disease specialist at Emory’s Children’s Center in Atlanta, Georgia, and Craig Wilson, MD, director of the University of Alabama at Birmingham’s Sparkman Center for Global Health.

Dr. Wilson spoke early on in the session, and reported that, although adolescents infected with HIV tend to have quarterly doctor’s visits, they may not have much interaction with medical practitioners or other healthcare providers who might influence their behaviors between visits. “There has to be more support care,” he stated.

Later, Dr. Comacho-Gonzalez shared results of an extended survey of HIV-infected adolescents that he had conducted with his team at Emory University. He began by noting that according to CDC Youth Risk Behavior Surveillance Systems, adolescent males tend to be more sexually active than females. Furthermore, about a quarter (24%) of ninth graders and more than half (58%) of twelfth graders report being sexually active. “About 20 million new STDs are diagnosed each year, and about half of those are in patients ages 15 to 24,” he noted. He added that about 11% of subjects who tested positive for chlamydia, Neisseria, and trichomonas reported that they had not had sex in the last 12 months; 6% reported never having had sex at all. “The youth are having lots of sex and actually lying about it, which is not very reassuring,” Dr. Comacho-Gonzalez observed.

The physician went on to say that these numbers have led his team to conclude that not only do HIV-infected youth have more sex and at an earlier age, but that they also tend to have more sexually transmitted infections (STIs). “HIV and STIs are risk factors to each other,” he stated, adding that although poor HIV control is related to increased risk of STI, “it’s not really clear which one weighs more than the other. There are both behavioral and biological reasons for this.”

To further investigate this association, Dr. Comacho-Gonzalez and his research team evaluated 1,200 female sex workers in Kenya to determine whether or not those women were more likely to have STIs, HIV, or both. Of the patient population, 994 (n) had non-perinatally-acquired HIV that was not controlled.

“We defined HIV control as a mean viral load <500 copies/mL,” he explained. The group also found that study participants who had poorly controlled HIV also had a tendency to have poorly controlled HPV, although the same did not hold true for those infected with chlamydia. “For some reason, people who have less competent immune systems are more likely to not control chronic infections like HPV,” he said.

The team concluded that there are many behavioral issues associated with poorly controlled HIV regardless of age or gender. They cited poverty, discrimination, stigma, psychiatric comorbidities, and drug abuse as contributing factors that could affect both HIV-infected adolescents in the United States and Kenyan sex workers. “There is plenty of data to show that these conditions and associated behaviors are related to HIV and STI infection,” said Dr. Comacho-Gonzalez.

The team believes that although more research is needed to determine whether HIV contributes to an increased risk for STIs or vice versa, the relationship is certainly present.