The Estimated Number and Lifetime Medical Cost of HIV Infections Attributable to Sexually Transmitted Infections Acquired in the United States in 2018: A Compilation of Published Modeling Results

Abstract

Background:The purpose of this study was to estimate the number and lifetime medical cost of HIV infections attributable to incident sexually transmitted infections (STIs) in the United States in 2018. Methods:We combined data from published models regarding the number or percentage of HIV infections attributable to STIs with updated estimates of the lifetime medical cost per HIV infection. We used 2 distinct calculation methods. Our first calculation used recent estimates of the percentage of HIV infections in men who have sex with men (MSM) attributable to gonorrhea and chlamydia. Our second calculation, based on older studies, used estimates of the expected number of STI-attributable HIV infections per new STI infection, for gonorrhea, chlamydia, syphilis, and trichomoniasis.Results: Our first calculation method suggested that 2489 (25th-75th percentiles, 1895-3000) HIV infections in 2018 among MSM could be attributed to gonorrhea and chlamydia, at an estimated lifetime medical cost of $1.05 billion (25th-75th percentiles, $0.79-$1.26 billion). Our second calculation method suggested that 2349 (25th-75th percentiles, 1948-2744) HIV infections in the general population (including MSM) could be attributed to chlamydia, gonorrhea, syphilis, and trichomoniasis acquired in 2018, at an estimated lifetime medical cost of $0.99 billion (25th-75th percentiles, $0.80-$1.16 billion).Conclusions: Despite ambiguity regarding the degree to which STIs affect HIV transmission, our combination of data from published STI/HIV transmission models and an HIV lifetime medical cost model can help to quantify the estimated burden of STI-attributable HIV infections in the United States.

The Estimated Direct Lifetime Medical Costs of Sexually Transmitted Infections Acquired in the United States in 2018

“…We obtained estimates of the number and cost of HIV infections attributable to other STIs from multiple modeling studies, as compiled and calculated elsewhere in this Special Issue. 31 An estimated 2489 HIV infections in 2018 among gay, bisexual, and other men who have sex with men (MSM) could be attributed to gonorrhea and chlamydia, at an estimated lifetime cost of $1.05 billion. 31 The 2489 result was calculated as 24,400 multiplied by 10.2%, where 24,400 is the estimated number of HIV infections acquired in 2018 through male-to-male sexual contact 32 and 10.2% is the estimated percent of HIV infections among MSM attributable to the facilitative effects of chlamydia and gonorrhea on HIV transmission and acquisition.…”

“…31 An estimated 2489 HIV infections in 2018 among gay, bisexual, and other men who have sex with men (MSM) could be attributed to gonorrhea and chlamydia, at an estimated lifetime cost of $1.05 billion. 31 The 2489 result was calculated as 24,400 multiplied by 10.2%, where 24,400 is the estimated number of HIV infections acquired in 2018 through male-to-male sexual contact 32 and 10.2% is the estimated percent of HIV infections among MSM attributable to the facilitative effects of chlamydia and gonorrhea on HIV transmission and acquisition. 33 Using another modeling approach, an estimated 2349 HIV infections in the general population (including MSM) could be attributed to chlamydia, gonorrhea, syphilis, and trichomoniasis acquired in 2018, at an estimated lifetime cost of $0.99 billion.…”

“…These STI-specific articles also allow for discussion of key STI-specific issues, such as the effect of HIV preexposure prophylaxis on the proportion of HIV infections attributable to STIs, 31 declines in the burden of HPV in the HPV vaccination era, 15,44 and potential increases in gonorrhea costs in the future due to increases in antimicrobial resistance. 10,31 Third, we accounted for uncertainty not only in the estimated cost per infection but also in the estimated number of incident infections.…”

“…[10][11][12][13]15 Because full articles were devoted to estimating the lifetime cost of a single STI or a group of related STIs, the methods, assumptions, and data sources have been described and documented in far more detail than previously. These STI-specific articles also allow for discussion of key STI-specific issues, such as the effect of HIV preexposure prophylaxis on the proportion of HIV infections attributable to STIs, 31 declines in the burden of HPV in the HPV vaccination era, 15,44 and potential increases in gonorrhea costs in the future due to increases in antimicrobial resistance. 10,31 Third, we accounted for uncertainty not only in the estimated cost per infection but also in the estimated number of incident infections.…”

Care/Support, Location, and the Monitoring/Evaluation of HIV/AIDs Prevention Programs: The Case of Southern Senatorial District of Cross River State, Nigeria

“…A more recent study discovered that HIV prevalence was 5.35%, and there is a significant difference when comparing the rates of new HIV infections among 1028 feverish individuals and blood donors (Olusola, Olaleye, and Odaibo 2021). Other recent studies have documented that even though there is no cure or HIV vaccine now, technological developments (in areas such as HIV testing, rapid and sustained treatment, pre-exposure prophylaxis and robust syringe service programs) have the potential to significantly reduce the number of new HIV infections (Bosh et al 2021;Chesson et al 2021;Giguère et al 2021;Rendina et al 2021;Romero et al 2021). Reducing HIV transmission, morbidity, and mortality might be sped up, and inequities could be narrowed by stepping up efforts to execute these methods fairly and equally.…”