Improvements in Virologic Control Among PWH Over Time: Narrowing the Gap Between Those With and Without STIs

Using the incidence of bacterial sexually transmitted infection (STI) as a surrogate for condomless sexual behavior, we assessed the association between STI and uncontrolled HIV replication among in-care persons with HIV (PWH) enrolled in a longitudinal HIV cohort study in the District of Columbia (the DC Cohort). Although STI occurrence initially correlated with higher HIV viral load (VL), this difference became more attenuated over time (2012-2016). This was true overall and among those with the greatest number of STIs [age 18-34, men who have sex with men (MSM)]. This likely reflects gains in population-wide virologic control through improved antiretroviral therapy and access to care, which helps mitigate the risk of HIV transmission.

Automated summary

By using bacterial sexually transmitted infection as a surrogate for condomless sexual behavior, this study assessed the association between STI and uncontrolled HIV replication. The results showed that the correlation between STI occurrence and HIV viral load attenuated over time, possibly due to improvements in antiretroviral therapy and access to care, leading to population-wide virologic control and reduced risk of HIV transmission.