Epi Profile Section 7 – Comorbidities in Texans Living with HIV

Sexually Transmitted Diseases (STD) in Texans Living with HIV  

STDs are infections that spread from person to person through sexual activity, including anal, vaginal, or oral sex. HIV is an STD, and chlamydia (CT), gonorrhea (GC), and syphilis [13] are also STDs. You can learn more in the Texas STD Surveillance Report for 2018. 

Having an STD can make it easier to get HIV. For example, an STD can cause a sore or a break in the skin, which can make it easier for HIV to enter the body. Having an STD can make it easier to transmit HIV, but only if the person living with HIV is not on antiretroviral treatment (ART). [14]  If the person living with HIV is on ART, then an STD does not increase the risk of transmitting HIV. [15]  Finally, people living with HIV can get an STD even if they are on ART. 

Between 2011 and 2018, the overall annual number of Texans with an STD diagnosis rose sharply (Table 18). Most notable were the 53% increase in the number of Texans diagnosed with gonorrhea and the 91% increase in primary or secondary (P&S) syphilis diagnoses. This growth was not due to growth in the overall population, because rates of STD also rose. 

The annual number of PLWH with STD also increased. The number of PLWH with a chlamydia or a gonorrhea diagnosis more than tripled. The number of PLWH with a P&S syphilis diagnosis doubled. Rates for all STD rose for both the overall population and PLWH. The STD increases likely reflect increased testing and improved reporting as well as true increases in the number of people with these STDs.
 

Table 18: Number and rate (per 1,000) of selected STD for all Texans and Texans living with HIV, 2011 and 2018

Source: Texas eHARS, 2018

Comparing rates can uncover health disparities. PLWH carry a much higher burden of STD than the general population. In 2018, rate of CT in PLWH was 6 times higher than the overall population rate, the GC rate was 22 times higher, and the P&S Syphilis rate was 94 times higher. In general, STD rates are higher in transgender women and in non-transgender men; in Black PLWH; in PLWH between 15 and 34 years old; and in MSM living with HIV, especially Black MSM (Table 20). 

MSM have been particularly hard hit by syphilis. MSM made up the largest group of people with P&S and early latent syphilis diagnoses in 2018. MSM living with HIV made up about a quarter of Texans with P&S and early latent syphilis diagnoses in 2018 (Table 19). 
 

Table 19: 2018 Syphilis diagnoses in Texas MSM

Source: Texas eHARS, 2018
 

Table 20: Rates of STD in PLWH (per 1,000), 2018

PLWH with unknown age are not broken out, but they are included in the total for each disease. The count of MSM in this table differs from others in this report because the methods used to redistribute case reports with no known risk cannot be used with matched data. 

Source: Texas eHARS, 2018
 

Tuberculosis in People Living with HIV

The rate of Tuberculosis (TB) in Texas PLWH is 15.7 times higher than in the general population (4.0/100,000). Yet, TB is still relatively rare in PLWH–less than 2% of the Texans living with HIV in 2018 had been diagnosed with TB in the years following their HIV diagnosis. PLWH who also have latent TB infections are more likely to develop TB disease because their immune system is weakened. 

As seen in Table 21, Hispanic and Black PLWH made up 85% of those co-infected with TB in 2018. Although not shown in this table, persons of Asian descent living with HIV are more likely to develop TB disease. The disproportionate impact on these three groups is shown in their higher rates, which is due to a higher prevalence of latent TB infection in these populations. 
 

Table 21: Number and percent of Texas PLWH with a TB co-morbidity

* The percentages do not add up to 100% as multi-race and other race/ethnic categories were not illustrated for brevity.
 

Note 13. Syphilis is divided into four stages: primary, secondary, latent, and tertiary. It is most transmissible during the primary and secondary stages and can also be transmitted in the early latent stage.

Note 14. Cohen MS, Hoffman IF, Royce RA, et al. Reduction of concentration of HIV-1 in semen after treatment of urethritis: implications for prevention of sexual transmission of HIV-1. Lancet 1997; 349:1868-1873.

Note 15. Cohen MS, Council OD, Chen JS. Sexually transmitted infections and HIV in the era of antiretroviral treatment and prevention:  the biologic basis for epidemiologic synergy. Journal of the International AIDS Society 2019, 22(s6) e25355.
 

Texas HIV Epidemiologic Profile