Background: Epidemiological evidences suggest a synergistic relationship between Human Immunodeficiency Virus (HIV) and N. gonorrheae in co-infected individuals. The objectives of this study were; 1) to test whether age at HIV between those with a history of N. gonorrheae infection was younger as compared to those with no history of reported N. gonorrheae infection, 2) to test whether age at HIV progression event (death or Acquired Immune Deficiency Syndrome (AIDS)) was younger as well as time from HIV diagnosis to HIV progression event was reduced in individuals with a history of N. gonorrheae infection as compared to those without, 3) to investigate the geospatial distribution of HIV and N. gonorrheae in the State of Michigan, and 4) to investigate the differences in biological markers (CD4 cell count and viral load) in a sub-population of HIV N. gonorrheae co-infected individuals.Methods: A retrospective cohort study from 2005-2011 was conducted in collaboration with Michigan Department of Community Health on Michigan HIV positive males with a history of N. gonorrheae infection between 2005-2011 as well as HIV positive males with no history of N. gonorrheae infection who were alive at the start of 2005. A sub-group analysis of Michigan HIV positive males with a reported N. gonorrheae infection between 2011 and 2013 to investigate biological markers of HIV progression. Spatial, survival, and linear regression analyses were performed on the data to evaluate the objectives of the study.Results: Mean age at HIV diagnosis was found to be younger in individuals with pre-HIV N. gonorrheae infections. On average males with 2 or more pre-HIV N. gonorrheae infections were 10.2 years younger than individuals with no N. gonorrheae infections, and males with only one pre-HIV N. gonorrheae infection were 7.3 years younger at HIV diagnosis. Hazard of AIDS increased in males with post-HIV N. gonorrheae infections, with individuals with multiple post-HIV N. gonorrheae infections having increase in hazard of progression to AIDS. A longer HIV to AIDS lag time period was observed in males with multiple post-HIV gonorrhea. Geospatial analysis showed that the area around the City of Detroit and the Tri-County area of Oakland, Macomb, and Wayne have the highest burden of disease due to co-infection as well as represent the most likely clusters for HIV N. gonorrheae co-infections. CD4 cell count was found to increase in the year during N. gonorrheae infection as well as in the years after as compared to pre-gonorrhea levels. Similarly viral load was found to increase in the year during N. gonorrheae infection, however, it did not remain elevated as compared to the pre-gonorrhea states. Conclusion: This study is a first step in documenting the possible synergistic relationship between N. gonorrheae infection and HIV. The study found that age at HIV and age at HIV progression event were reduced (younger at event) than in those with no history of gonorrhea. The study also identified areas of concern using geospatial analysis where resources should be focused to try and reduce and disease. Paradoxically the time from HIV to HIV progression event was increased in those with N. gonorrheae infections as compared to those without. Finally the study found that CD4 cell count was increased in the time period during and after N. gonorrheae infection, and that viral load was increased in the year during N. gonorrheae infection, but returned to pre-gonorrhea levels in the years following.
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