During this study period, 4.6% (9471/205,689) of the reported GCs occurred among persons with previously diagnosed HIV: 5.5% (5930/107,786) in NYC, 7.3% (1312/17,910) in DC, 4% (1504/40,214) in MDC, and 2% (725/39,779) in AZ. The percent of GCs with HIV coinfection increased in all jurisdictions over the study period from 3% (367/12,314) in 2000 to 7% (752/10,553) in 2008 in NYC (P < 0.001), 6.4% (142/2211) to 6.7% (155/2302) in DC (P < 0.001), 2% (91/3917) to 4% (165/4265) in MDC (P < 0.001), and 0.7% (31/4400) to 3% (91/3486) in AZ (P < 0.001) (Fig. 1). The overall male-to-female ratio of HIV-GC coinfected cases for the period was 6.4 in NYC, 3.2 in both DC and MDC, and 29.2 in AZ (Table 1). Across all the 4 jurisdictions, 7.4% of male GCs had been previously diagnosed with HIV. The highest male coinfection rates were 10.5% in DC and 9.3% in NYC. In each of the 4 jurisdictions, the majority of HIV/GC coinfections were among men: 87% (5127/5927) in NYC, 76% in both DC (1000/1311) and MDC (1144/1504), and 97% (701/725) in AZ. Among male GCs in each jurisdiction, HIV coinfection was highest among the age groups 40–44 and 45–49 years. Among male GCs, the race/ethnicity group with the highest percent HIV coinfection was white non-Hispanic in each jurisdiction: 22% in NYC, 11% in DC (11%), 11% in MDC, and 7% in AZ (Table 1).
There are several limitations to this analysis and the use and interpretation of these data. Underestimates of coinfections likely occurred due to differences in matching variables, jurisdictional reporting, and reporting delays. Information regarding risks of HIV transmission, such as sexual network, risk behaviors, condom use, and HIV medication adherence were not analyzed; therefore, these data cannot be used to describe contemporaneous HIV medical control efforts or ongoing risk behaviors. These data reflect increases in coinfection case counts and not rates at which persons with HIV acquire GC. Anatomical site of GC infection was not available for these cases, thus genital versus nongenital (oral, rectal) infection could not be quantified. This analysis did not consider chlamydial infections because the number of chlamydia cases reported among HIV-infected persons is smaller (given the female preponderance of reported chlamydia) and did not allow for a detailed analysis. Finally, these data do not control for screening practices. Thus, increases in coinfections could be due to increases in routine screening for STDs among persons with HIV, especially at nongenital sites.
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