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

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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.

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We would like to thank the site Principal Investigators, Research Assistants, the Community Advisory Board, the patients themselves, the DC Department of Health, and the National Institutes of Health (NIH) for their contributions to the DC Cohort. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Data in this manuscript were collected by the DC Cohort Study Group with investigators and research staff located at: Children’s National Medical Center Adolescent (Lawrence D’Angelo) and Pediatric (Natella Rakhmanina) clinics; The Senior Deputy Director of the DC Department of Health HAHSTA (Michael Kharfen); Family and Medical Counseling Service (Michael Serlin); Georgetown University (Princy Kumar); The George Washington University Biostatistics Center (Vinay Bhandaru, Tsedenia Bezabeh, Nisha Grover-Fairchild, Lisa Mele, Susan Reamer, Alla Sapozhnikova, Greg Strylewicz, Marinella Temprosa, Naji Younes, and Kevin Xiao); The George Washington University Department of Epidemiology (Morgan Byrne, Amanda Castel, Alan Greenberg, Maria Jaurretche, Paige Kulie, Anne Monroe, James Peterson, Bianca Stewart, and Brittany Wilbourn) and Department of Biostatistics and Bioinformatics (Yan Ma); The George Washington University Medical Faculty Associates (Hana Akselrod); Howard University Adult Infectious Disease Clinic (Jhansi L. Gajjala) and Pediatric Clinic (Sohail Rana); Kaiser Permanente Mid-Atlantic States (Michael Horberg); La Clinica Del Pueblo (Ricardo Fernandez); MetroHealth (Annick Hebou); National Institutes of Health (Carl Dieffenbach, Henry Masur); Washington Health Institute, formerly Providence Hospital (Jose Bordon); Unity Health Care (Gebeyehu Teferi); Veterans Affairs Medical Center (Debra Benator); Washington Hospital Center (Maria Elena Ruiz); and Whitman-Walker Institute (Stephen Abbott).


The DC Cohort is funded by the National Institute of Allergy and Infectious Diseases, UM1 AI069503 and 1R24AI152598-01. This research was supported by the District of Columbia Center for AIDS Research, an NIH funded program (AI117970), which is supported by the following NIH CoFunding and Participating Institutes and Centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, FIC, NIGMS, NIDDK, and OAR. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Correspondence to Morgan Byrne.

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IRB APPROVAL: #071029 George Washington University IRB.

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Participants in the DC Cohort consent to have their demographic and clinical data electronically and manually abstracted from medical records at the participating sites, entered into a centralized database and linked to DC Department of Health HIV/AIDS, Hepatitis, STD, TB Administration (DC HAHSTA) surveillance databases.

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Akselrod, H., Byrne, M., Lundberg, J. et al. Improvements in Virologic Control Among PWH Over Time: Narrowing the Gap Between Those With and Without STIs. AIDS Behav 27, 673–677 (2023).

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