Newly Diagnosed HIV Infection
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《新英格兰医药杂志》
To the Editor: In his article on the management of newly diagnosed human immunodeficiency virus (HIV) infection (Oct. 20 issue),1 Hammer did not specifically recommend screening for gonorrhea and chlamydia. These often asymptomatic infections can cause disease, increase the transmissibility of HIV,2 and result in elevated plasma levels of HIV type 1 (HIV-1) RNA and decreased CD4 cell counts.3,4
In a study of early HIV infection, we screened all patients with newly diagnosed HIV for pharyngeal, urethral, and rectal gonorrhea 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 have sex with men; the median age was 36 years (interquartile range, 30 to 40), the median plasma HIV-1 RNA level was 22,097 copies per milliliter (interquartile range, 3306 to 168,730), and the median number of sex partners during the six months before testing was three (interquartile range, two to four). We detected rectal gonorrhea in six patients (12 percent), rectal chlamydia in five (10 percent), pharyngeal gonorrhea in four (8 percent), and urethral gonorrhea in one (2 percent). Overall, we diagnosed one or more sexually transmitted diseases in 12 patients (23 percent).
U.S. federal guidelines recommend periodic screening for gonorrhea and chlamydia in HIV-infected persons.5 The high prevalence of gonorrhea and chlamydia in our study supports the use of comprehensive screening for patients with newly diagnosed HIV infection 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@itsa.ucsf.edu
Dr. Hecht reports having received lecture fees from Gen-Probe and Abbott; and Dr. Klausner, lecture fees from King Pharmaceuticals and grant support from Pfizer.
References
Hammer SM. Management of newly diagnosed HIV infection. N Engl J Med 2005;353:1702-1710.
Wasserheit JN. Epidemiological synergy: interrelationships between human immunodeficiency virus infection and other sexually transmitted diseases. Sex Transm Dis 1992;19:61-77.
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.
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.
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.
The author replies: The importance of gonorrhea, chlamydia, and other sexually transmitted infections with respect to initial screening for HIV infection was noted in the article, as was the importance of the use of condoms both to prevent the acquisition of sexually transmitted infections and to promote secondary prevention of the spread of HIV-1. The list of recommended laboratory tests (which included tests for several other pathogens that can be acquired through sexual contact) did not include screening for gonorrhea and chlamydia, but it certainly could have. The consensus U.S. recommendations1 referred to by Chin-Hong et al. and these authors' data on a population of men who have sex with men support data-driven decision making with regard to the optimal testing strategies for sexually transmitted infections in populations at risk.
Scott M. Hammer, M.D.
Columbia University Medical Center
New York, NY 10032
smh48@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.
In a study of early HIV infection, we screened all patients with newly diagnosed HIV for pharyngeal, urethral, and rectal gonorrhea 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 have sex with men; the median age was 36 years (interquartile range, 30 to 40), the median plasma HIV-1 RNA level was 22,097 copies per milliliter (interquartile range, 3306 to 168,730), and the median number of sex partners during the six months before testing was three (interquartile range, two to four). We detected rectal gonorrhea in six patients (12 percent), rectal chlamydia in five (10 percent), pharyngeal gonorrhea in four (8 percent), and urethral gonorrhea in one (2 percent). Overall, we diagnosed one or more sexually transmitted diseases in 12 patients (23 percent).
U.S. federal guidelines recommend periodic screening for gonorrhea and chlamydia in HIV-infected persons.5 The high prevalence of gonorrhea and chlamydia in our study supports the use of comprehensive screening for patients with newly diagnosed HIV infection 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@itsa.ucsf.edu
Dr. Hecht reports having received lecture fees from Gen-Probe and Abbott; and Dr. Klausner, lecture fees from King Pharmaceuticals and grant support from Pfizer.
References
Hammer SM. Management of newly diagnosed HIV infection. N Engl J Med 2005;353:1702-1710.
Wasserheit JN. Epidemiological synergy: interrelationships between human immunodeficiency virus infection and other sexually transmitted diseases. Sex Transm Dis 1992;19:61-77.
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.
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.
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.
The author replies: The importance of gonorrhea, chlamydia, and other sexually transmitted infections with respect to initial screening for HIV infection was noted in the article, as was the importance of the use of condoms both to prevent the acquisition of sexually transmitted infections and to promote secondary prevention of the spread of HIV-1. The list of recommended laboratory tests (which included tests for several other pathogens that can be acquired through sexual contact) did not include screening for gonorrhea and chlamydia, but it certainly could have. The consensus U.S. recommendations1 referred to by Chin-Hong et al. and these authors' data on a population of men who have sex with men support data-driven decision making with regard to the optimal testing strategies for sexually transmitted infections in populations at risk.
Scott M. Hammer, M.D.
Columbia University Medical Center
New York, NY 10032
smh48@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.