Table 3.
Summary of results on the effect of STI diagnosis on risk of HIV Acquisition among MSM by multivariate adjustment, geography, temporality, high quality data and combined (k=39)
| Syphilis | Gonorrhea | Chlamydia | ||||
|---|---|---|---|---|---|---|
| Geography | OECD* | Non-OECD | OECD | Non-OECD | OECD | Non-OECD |
| Pooled RR (95%) | 2.61 (1.44, 4.74) | 2.52 (1.85, 3.44) | 1.90 (1.51, 2.40) | 2.88 (1.00, 8.28) | 1.90 (1.49, 2.42) | 2.04 (1.27, 3.26) |
| I2, p value | 73.0%, p<0.001 | 50.1%, p=0.029 | 26.3%, p=0.237 | 92.5%, p<0.001 | 0.0%, p=0.459 | 66.4%, p=0.051 |
| K | 9 | 11 | 6 | 5 | 4 | 3 |
| Multivariate Adjustment | Unadjusted RR | Adjusted RR | Unadjusted RR | Adjusted RR | Unadjusted RR | Adjusted RR |
| Pooled RR (95%) | 2.10 (1.63, 2.70) | 3.34 (2.11, 5.28) | 1.66 (1.26, 2.19)† | 3.48 (1.59, 7.59) | 1.99 (1.59, 2.48) | -- |
| I2, p value | 17.2%, p=0.280 | 74.1%, p<0.001 | 37.3%, p=0.172 | 89.3%, p<0.001 | 30.9%, p=0.192 | -- |
| K | 11 | 10 | 5 | 6 | 7 | -- |
| Risk of Bias: Temporality ‡ | Less Risk | More Risk | Less Risk | More Risk | Less Risk | More Risk |
| Pooled RR (95%) | 3.33 (2.44, 4.56) | 1.93 (1.36, 2.75) | 2.58 (1.53, 4.32) | 1.81 (1.26, 2.60) | 1.78 (1.46, 2.16) | 2.89 (1.96, 4.26) |
| I2, p value | 51.0%, p=0.026 | 42.4%, p=0.075 | 87.0%, p<0.001 | 0.0%, p=0.342 | 0.0%, p=0.567 | NA |
| K | 11 | 10 | 9 | 2 | 6 | 1 |
| Risk of Bias: Testing § | Less Risk | More Risk | Less Risk | More Risk | Less Risk | More Risk |
| Pooled RR (95%) | 2.83 (2.03, 3.94) | 2.18 (1.16, 4.11) | 2.34 (1.42, 3.85) | 2.25 (1.46, 3.47) | 1.96 (1.50, 2.55) | 2.20 (1.40, 3.46) |
| I2, p value | 70.2%, p=0.000 | 51.6%, p=0.083 | 87.1%, p<0.001 | 3.7%, p=0.308 | 40.4%, p=0.136 | NA |
| K | 16 | 5 | 9 | 2 | 6 | 1 |
| High Quality Data ¶ | Model 1 | Model 2 | Model 1 | Model 2 | Model 1 | Model 2 |
| Pooled RR (95%) | 4.32 (2.20, 8.51) | 4.25 (2.51, 7.21) | 5.49 (1.11, 27.05) | 4.23 (1.66, 10.77) | -- | -- |
| I2, p value | 75.3%, p=0.007 | 67.3%, p=0.016 | 93.8%, p<0.001 | 90.0%, p<0.001 | -- | -- |
| K | 4 | 5 | 3 | 5 | -- | -- |
| Combined | Combined | Combined | Combined | |||
| Pooled RR (95%) | 2.68 (2.00, 3.58) | 2.38 (1.56, 3.61)** | 1.99 (1.59, 2.48) | |||
| I2, p value | 66.3%, p=0.000 | 84.2%, p= p<0.001 | 30.9%, p=0.192 | |||
| K | 21 | 11 | 7 | |||
| SA RR Range || | 2.39–2.83 | 1.81–2.60 | 1.78–2.13 | |||
OECD countries are members of the Organisation for Economic Co-operation and Development (OECD). Study data is drawn from the following OECD countries: Australia, Italy, Portugal, United Kingdom, United States, and a multi-country study. Study data is drawn from the following non-OECD countries: Brazil, China, Kenya, Thailand.
If Meireles 2015 (RR=0.002, CI= 0.001, 0.003) is included then the pooled estimate for unadjusted RR would be 0.52 (0.07, 4.05).
Risk of bias in temporality is defined as more risk where there was an interval of >12 months between STI exposure and HIV outcome assessments and less risk where the interval <=12 months. Incident STI exposure treated as a fixed variable is classified as higher risk of bias.
Risk of bias in testing is defined as more risk if STI exposure and/or HIV outcome were drawn from medical records and less risk if investigators reported using laboratory test for both STI and HIV.
Model 1: Data excluded if: HIV and STI assessment was based on medical records (vs. if directly confirmed by lab test), if there was no attempt to match or adjust for confounders, a case-control study design was used, and/or assessment intervals were > 12 months.
Model 2: Data excluded if: There was no attempt to match or adjust for confounders and/or assessment intervals were >12 months.
Sensitivity analysis RR range when one study removed from analysis
If Meireles 2015 (RR=0.002, CI= 0.001, 0.003) is included then the combined estimated RR would be 1.359 (0.420, 4.391).
K = Number of effect size estimates included; RR = Risk ratio; SA = Sensitivity analysis