Asymptomatic Rectal Bacterial Pathogens Show Large Prospective Relationships With HIV Incidence in a Cohort of Young Sexual and Gender Minorities: Implications for STI Screening and HIV Prevention

Ross A. Baiers, Daniel T. Ryan, Antonia Clifford, Erik Munson, Richard D’Aquila, Michael E. Newcomb, Brian Mustanski*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background. We estimated the predictive value of rectal (bacterial sexually transmitted infection [bSTI]) pathogen detection for future HIV seroconversion among young adult sexual and gender minorities (YSGMs) assigned male at birth (AMAB). Methods. Data were collected between March 2018 and August 2022 from RADAR, a longitudinal cohort study of YSGMs AMAB living in the Chicago metropolitan area (n = 1022). Rates of rectal bSTIs and the proportion of self-reported rectal bSTI symptoms are reported. We examined whether the presence of rectal bSTIs predicted HIV seroconversion using generalized estimating equations (GEEs). Results. Participants tested reactive for rectal Mycoplasma genitalium (MGen), Neisseria gonorrhoeae (NG), and Chlamydia trachomatis (CT) at a rate of 20.8 (95% CI, 18.4–23.5), 6.5 (95% CI, 5.0–8.2), and 8.4 (95% CI, 6.8–10.3) cases per 100 persons, respectively. There were no statistically significant pairwise differences in self-reported rectal bSTI symptoms between participants with self-collected swabs testing nonreactive vs reactive for rectal MGen (χ2 = 0.04; P = .84), NG (χ2 = 0.45; P = .37), or CT (χ2 = 0.39; P = .46). In multivariate GEE analysis, rectal NG (adjusted odds ratio, 5.11; 95% CI, 1.20–21.77) was a statistically significant predictor of HIV seroconversion after controlling for other bSTIs, demographics, and sexual risk behavior. Conclusions. Our findings provide a robust longitudinal estimation of the relationship between primarily asymptomatic rectal NG nucleic acid detection and HIV infection. These findings highlight the importance of asymptomatic screening for bSTIs and targeting biobehavioral intervention to prevent HIV infection among YSGMs with rectal bSTI agents detected.

Original languageEnglish (US)
Article numberofae444
JournalOpen Forum Infectious Diseases
Volume11
Issue number8
DOIs
StatePublished - Aug 1 2024

Funding

Financial support. This research was supported by the National Institute on Drug Abuse (U01DA036939; PI: Mustanski). The content of this article is solely the responsibility of the authors and does not necessarily reflect the views of the National Institutes of Health or the National Institute on Drug Abuse.

Keywords

  • HIV incidence
  • HIV risk
  • asymptomatic sexually transmitted infection
  • men who have sex with men
  • sexually transmitted diseases

ASJC Scopus subject areas

  • Oncology
  • Infectious Diseases

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