Risk factors for Sexually Transmitted Infections in people living with Human Immunodeficiency Virus (Saskatoon health service data and Systematic review/Meta-analysis).

Background: Globally over a million people are infected daily with a sexually transmitted infection (STI), giving rise to a major global health threat. Sexually transmitted infections have also been on the rise in Saskatoon Health Region (SHR). The region has the largest number of people living with HIV (PLWH) in the province of Saskatchewan. Globally, the prevalence of STIs have been reported to be high among PLWH. The diagnosis of other STIs in PLWH suggests the possibility that PLWH are putting non-infected individuals at risk of HIV infection. Thus, identification of subgroups of PLWH at risk of acquiring other STIs is essential to guide intervention programs, such as to prevent further transmission of HIV and other STIs. Studies exploring risk factors for STI acquisition amongst PLWH are not available in SHR, and limited in Canada overall. Objectives: 1. To explore whether either gender or IDU are risk factors for STI acquisition in the year before and after HIV diagnosis in SHR. 2. To determine if gender is a risk factor for acquiring STIs among PLWH in developed countries. 3. To determine if IDU is a risk factor for acquiring STIs among PLWH in developed countries. Methods: Objective 1: Saskatoon Health Region health service data on PLWH with and without STIs during the years 2009 to 2014 were examined. Twenty-two PLWH with an STI diagnosis within a year before and after HIV diagnosis were compared to one hundred and thirty-three PLWH without an STI diagnosis for variables potentially associated with STI acquisition in HIV. Objective 2&3: A systematic review and meta-analysis was conducted according to Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Effective Public Health Practice Project (EPHPP) recommendations. Its reporting was guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies from developed countries addressing acquisition of other STIs in PLWH were identified. Relevant data were abstracted and differences in odds ratios (OR) across the studies and heterogeneity were examined using meta-analysis. Results Objective 1: Multivariable analysis showed an association with marginal statistical significance between female gender (OR: 4.99; CI: 0.89-27.3) and the risk for STI acquisition in the year before and after HIV diagnosis in SHR. There was also a significant association between sex work (OR: 5.0; CI: 1.03 -24.6) and the risk for STI acquisition in PLWH during this period in SHR. No association was observed between IDU and the risk for STI acquisition in the year before and after HIV diagnosis in SHR (OR: 0.20; CI: 0.03-1.2). No interaction was observed between the variables. Objectives 2 & 3: Ten articles were reviewed for the gender analysis.The pooled OR for HIV-infected females acquiring other STIs compared to males was 1.38 (CI: 0.75-2.55), with a high heterogeneity of I2 = 96%. For the IDU analysis, six articles were reviewed. The pooled OR for IDUs acquiring other STIs compared to non-IDU was 0.71 (CI: 0.4-1.29), with a high heterogeneity of I2 = 85%. Conclusion: In the face of scarce resources public health practitioners should prioritize programs to address HIV subgroups more at risk for STI acquisition. Special programs may also be necessary to reach certain high-risk groups