To the Editor: In his article on the management of newly diagnosedhuman immunodeficiency virus (HIV) infection (Oct. 20 issue),1Hammer did not specifically recommend screening for gonorrheaand chlamydia. These often asymptomatic infections can causedisease, increase the transmissibility of HIV,2 and result inelevated plasma levels of HIV type 1 (HIV-1) RNA and decreasedCD4 cell counts.3,4
In a study of early HIV infection, we screened all patientswith newly diagnosed HIV for pharyngeal, urethral, and rectalgonorrhea and chlamydia with the use of nucleic acid amplification(BD ProbeTec ET, BD Diagnostic Systems; APTIMA Combo 2 assay,Gen-Probe). Among 52 patients, 98 percent were men who havesex with men; the median age was 36 years (interquartile range,30 to 40), the median plasma HIV-1 RNA level was 22,097 copiesper milliliter (interquartile range, 3306 to 168,730), and themedian number of sex partners during the six months before testingwas three (interquartile range, two to four). We detected rectalgonorrhea in six patients (12 percent), rectal chlamydia infive (10 percent), pharyngeal gonorrhea in four (8 percent),and urethral gonorrhea in one (2 percent). Overall, we diagnosedone or more sexually transmitted diseases in 12 patients (23percent).
U.S. federal guidelines recommend periodic screening for gonorrheaand chlamydia in HIV-infected persons.5 The high prevalenceof gonorrhea and chlamydia in our study supports the use ofcomprehensive screening for patients with newly diagnosed HIVinfection as well.
Peter V. Chin-Hong, M.D. Frederick M. Hecht, M.D. Jeffrey D. Klausner, M.D., M.P.H. University of California at San Francisco San Francisco, CA 94143 pvch{at}itsa.ucsf.edu
Dr. Hecht reports having received lecture fees from Gen-Probeand Abbott; and Dr. Klausner, lecture fees from King Pharmaceuticalsand grant support from Pfizer.
References
Hammer SM. Management of newly diagnosed HIV infection. N Engl J Med 2005;353:1702-1710. [Free Full Text]
Wasserheit JN. Epidemiological synergy: interrelationships between human immunodeficiency virus infection and other sexually transmitted diseases. Sex Transm Dis 1992;19:61-77. [Web of Science][Medline]
Buchacz K, Patel P, Taylor M, et al. Syphilis increases HIV viral load and decreases CD4 cell counts in HIV-infected patients with new syphilis infections. AIDS 2004;18:2075-2079. [CrossRef][Web of Science][Medline]
Sadiq ST, Taylor S, Copas AJ, et al. The effects of urethritis on seminal plasma HIV-1 RNA loads in homosexual men not receiving antiretroviral therapy. Sex Transm Infect 2005;81:120-123. [Free Full Text]
Incorporating HIV prevention into the medical care of persons living with HIV: recommendations of CDC, the Health Resources and Services Administration, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep 2003;52:1-24. [Erratum, MMWR Morb Mortal Wkly Rep 2004;53:744.] [Medline]
The author replies: The importance of gonorrhea, chlamydia,and other sexually transmitted infections with respect to initialscreening for HIV infection was noted in the article, as wasthe importance of the use of condoms both to prevent the acquisitionof sexually transmitted infections and to promote secondaryprevention of the spread of HIV-1. The list of recommended laboratorytests (which included tests for several other pathogens thatcan be acquired through sexual contact) did not include screeningfor gonorrhea and chlamydia, but it certainly could have. Theconsensus U.S. recommendations1 referred to by Chin-Hong etal. and these authors' data on a population of men who havesex with men support data-driven decision making with regardto the optimal testing strategies for sexually transmitted infectionsin populations at risk.
Scott M. Hammer, M.D. Columbia University Medical Center New York, NY 10032 smh48{at}columbia.edu
References
Incorporating HIV prevention into the medical care of persons living with HIV: recommendations of CDC, the Health Resources and Services Administration, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep 2003;52:1-24. [Erratum, MMWR Morb Mortal Wkly Rep 2004;53:744.] [Medline]
Clark, J L, Konda, K A, Segura, E R, Salvatierra, H J, Leon, S R, Hall, E R, Caceres, C F, Klausner, J D, Coates, T J
(2008). Risk factors for the spread of HIV and other sexually transmitted infections among men who have sex with men infected with HIV in Lima, Peru. Sex. Transm. Infect.
84: 449-454
[Abstract][Full Text]
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