The Effect of Genital Tract Infections on HIV-1 Shedding in the Genital Tract: A Systematic Review and Meta-Analysis

Centre for Actuarial Research, University of Cape Town, South Africa.
Sexually transmitted diseases (Impact Factor: 2.84). 09/2008; 35(11):946-59. DOI: 10.1097/OLQ.0b013e3181812d15
Source: PubMed


This article reviews the effect of genital tract infections and associated clinical conditions on the detection and concentration of HIV-1 shedding in the genital tract. A search of the PubMed, Embase, and AIDSearch databases was conducted. Meta-analysis was performed on those studies that reported the effect of genital tract infections on the detection of HIV-1 shedding. Thirty-nine studies met the inclusion criteria. The odds of HIV-1 detection in the genital tract were increased most substantially by urethritis (OR 3.1, 95% CI: 1.1-8.6) and cervicitis (OR 2.7, 95% CI: 1.4-5.2). The odds of HIV-1 detection were also increased significantly in the presence of cervical discharge or mucopus (OR 1.8, 95% CI: 1.2-2.7), gonorrhoea (OR 1.8, 95% CI: 1.2-2.7), chlamydial infection (OR 1.8, 95% CI: 1.1-3.1), and vulvovaginal candidiasis (OR 1.8, 95% CI: 1.3-2.4). Other infections and clinical conditions were found to have no significant effect on the detection of HIV-1, although HSV-2 shedding was found to increase the concentration of HIV-1 shedding, and genital ulcer disease was found to increase the odds of HIV-1 detection significantly after excluding one biased study (OR 2.4, 95% CI: 1.2-4.9). This analysis shows that infections that are associated with significant increases in leukocyte concentrations in the genital tract are also associated with significant increases in HIV-1 shedding. These infections are likely to be particularly important in promoting the sexual transmission and mother-to-child intrapartum transmission of HIV-1, and should therefore be the focus of HIV prevention strategies.

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    • "Both partners should be screened for genital tract infections and treated if present. Genital tract inflammation is associated with genital tract shedding of HIV, even in the setting of fully suppressed HIV viral load, and may additionally increase plasma viremia [64, 65]. If untreated, genital tract infections may increase the risk of adverse pregnancy outcomes and potential perinatal transmission. "
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    Infectious Diseases in Obstetrics and Gynecology 10/2012; 2012:604183. DOI:10.1155/2012/604183
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    • "10, 11, 12 C. trachomatis is the most common sexually transmitted pathogen worldwide and a major cause of infertility.13 Genital Chlamydia infections also increase the susceptibility to other sexual transmitted agents such as HIV.14 Vaginal microbicides may be considered for prevention and control of local Chlamydia infections, but established infections may ascend to the ovarian tubes and therefore require systemic treatment. In order to identify lead compounds for anti-chlamydial drug development, we screened a library of 58 salicylidene acylhydrazides15 for their ability to inhibit Chlamydia growth. "
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    • "In the 'Base-cofactor scenario', STI cofactors are assumed to be consistent with odds ratios estimated in meta-analytic reviews (Røttingen et al. 2001; Freeman et al. 2006; Johnson & Lewis 2008). (Detailed justification of the choice of cofactor assumptions is provided in "
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    ABSTRACT: To assess the extent to which sexually transmitted infections (STIs) have contributed to the spread of HIV in South Africa and to estimate the extent to which improvements in STI treatment have reduced HIV incidence. A mathematical model was used to simulate interactions between HIV and six other STIs (genital herpes, syphilis, chancroid, gonorrhoea, chlamydial infection and trichomoniasis) as well as bacterial vaginosis and vaginal candidiasis. The effects of STIs on HIV transmission probabilities were assumed to be consistent with meta-analytic reviews of observational studies, and the model was fitted to South African HIV prevalence data. The proportion of new HIV infections in adults that were attributable to curable STIs reduced from 39% (uncertainty range: 24-50%) in 1990 to 14% (8-18%) in 2010, while the proportion of new infections attributable to genital herpes increased. Syndromic management programmes are estimated to have reduced adult HIV incidence by 6.6% (3.3-10.3%) between 1994 and 2004, by which time syndromic management coverage was 52%. Had syndromic management been introduced in 1986, with immediate achievement of 100% coverage and a doubling of the rate of health seeking, HIV incidence would have reduced by 64% (36-82%) over the next decade, but had the same intervention been delayed until 2004, HIV incidence would have reduced by only 5.5% (2.8-9.0%). Sexually transmitted infections have contributed significantly to the spread of HIV in South Africa, but STI control efforts have had limited impact on HIV incidence because of their late introduction and suboptimal coverage.
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