SEROCONVERSION IN PATIENTS ATTENDING SEXUALLY-TRANSMITTED DISEASE CLINICS

Objectives: To characterize recent HIV seroconverters in a sexually tr ansmitted disease (STD) clinic population, and examine changing transm ission patterns.Methods: We conducted a case-control study nested with in a retrospectively defined cohort of individuals attending Baltimore STD clinics between January 1988 and July 1990. Seroconverters, who t ested HIV-positive after having a negative test, were compared to both HIV-negative controls, who were also tested twice, and a second, prev alent HIV-positive control group. Controls were matched 2:1 by sex, cl inic, and month of HIV test. Results: Forty-nine out of 6175 (0.79%) p atients tested at least twice had documented HIV-1 seroconversion. On multivariate analysis, seroconversion was significantly associated wit h self-reported injecting drug use [odds ratio (OR), 7.3; 95% confiden ce interval (CI), 2.3-23)], with being a man who has had sex with othe r men (OR, 3.5; 95% CI, 1.2-10), or with having sex with a known HIV-i nfected person (OR, 11; 95% CI, 1.3-96). Thirty-five per cent of seroc onverters did not report a risk for HIV infection, and a higher propor tion of recent seroconverters also reported no risk. Compared to the p revalent positive control group, more seroconverters reported no risk and a lower proportion reported recognized risks. A diagnosis of gonor rhea was also significantly associated with seroconversion (OR, 2.5; 9 5% CI, 1.1-5.7). Conclusions: These data suggest increasing heterosexu al transmission of HIV in this inner-city STD clinic population. Incid ent STD, in particular gonorrhea, may increase a patient's risk for HI V infection, suggesting that patients with STD should be targeted aggr essively for HIV prevention activities.