Objectives. We estimated the risk of HIV associated with sexually transmitted
infection (STI) history during adolescence.
Methods. We retrospectively studied a cohort of adolescents (n = 75 273, born
in 1985–1993) who participated in the Philadelphia High School STD Screening
Program between 2003 and 2010. We matched the cohort to STI and HIV
surveillance data sets and death certificates and performed Poisson regression
to estimate the association between adolescent STI exposures and subsequent
HIV diagnosis.
Results. Compared with individuals reporting no STIs during adolescence,
adolescents with STIs had an increased risk for subsequent HIV infection
(incidence rate ratio [IRR] for adolescent girls = 2.6; 95% confidence interval
[CI] = 1.5, 4.7; IRR for adolescent boys = 2.3; 95% CI = 1.7, 3.1). Risk increased with
number of STIs. The risk of subsequent HIV infection was more than 3 times as
high among those with multiple gonococcal infections during adolescence as
among those with none.
Conclusions. Effective interventions that reduce adolescent STIs are needed
to avert future STI and HIV acquisition. Focusing on adolescents with
gonococcal infections or multiple STIs might have the greatest impact on
future HIV risk. (Am J Public Health. 2013;103:1874–1881. doi:10.2105/AJPH.
2013.301463)