Sexually transmitted infections in European HIV-infected women: incidence in relation to time from infection

Objectives: To investigate the prevalence and incidence of sexually transmi tted infections (STI) in HIV-infected women in relation to time from infect ion and sexual behaviour. Design: The European study on the natural history of HIV infection in women is a prospective cohort study of 487 HIV-infected women with a known inter val of seroconversion from 12 European countries. Methods: Incidence was measured with person-time methods. Generalized estim ating equations analysis was used to determine risk factors for STI. Results: At entry, 15% of the women were diagnosed with at least one acute STI (chlamydial infection, trichomoniasis or gonorrhoea), 10% with at least one other STI (genital warts or genital ulcerations) and 13% with vaginal candidiasis. Although frequently diagnosed during follow-up, the occurrence of acute STI and vaginal candidiasis decreased, whereas the occurrence of other STI increased with ongoing time from HIV infection. Furthermore, wome n with a history of prostitution [relative risk (RR), 2.00; 95% confidence interval (95% Cl), 1.20-3.33] and women with irregular condom use (RR, 7.74 ; 95% Cl, 3.52-17.0) were at higher risk for an acute STI. Conclusions: Although STI diagnoses were frequent, the occurrence of acute STI declined with time from infection which might be explained by changed s exual behaviour over time. The occurrence of other STI increased with time from HIV infection, presumably due to reactivation as a result of immunosup pression. (C) 2000 Lippincott Williams & Wilkins.