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

ArticleinSexually transmitted diseases 35(11):946-59 · September 2008with12 Reads
DOI: 10.1097/OLQ.0b013e3181812d15 · Source: PubMed
Abstract
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.
    • "To our knowledge, there is little evidence regarding the epidemiological effect of HIV infection on syphilis susceptibility [8]; we assume a 1·5 times increase in our main simulations (sensitivity analysis explored values of 1·0 and 2·5). We assume that HIV infectiousness increases up to 50% of its maximum possible level (reached during the acute phase) during a syphilis co-infection [7, 22]. Since evidence that HIV can increase syphilis infectiousness is weak, our model does not change syphilis infectiousness when there is a HIV co-infection. "
    [Show abstract] [Hide abstract] ABSTRACT: Despite the availability of inexpensive antimicrobial treatment, syphilis remains prevalent worldwide, affecting millions of individuals. Furthermore, syphilis infection is suspected of increasing both susceptibility to, and tendency to transmit, HIV. Development of a syphilis vaccine would be a potentially promising step towards control, but the value of dedicating resources to vaccine development should be evaluated in the context of the anticipated benefits. Here, we use a detailed mathematical model to explore the potential impact of rolling out a hypothetical syphilis vaccine on morbidity from both syphilis and HIV and compare it to the impact of expanded 'screen and treat' programmes using existing treatments. Our results suggest that an efficacious vaccine has the potential to sharply reduce syphilis prevalence under a wide range of scenarios, while expanded treatment interventions are likely to be substantially less effective. Our modelled interventions in our simulated study populations are expected to have little effect on HIV, and in some scenarios lead to small increases in HIV incidence, suggesting that interventions against syphilis should be accompanied with interventions against other sexually transmitted infections to prevent the possibility that lower morbidity or lower perceived risk from syphilis could lead to increases in other sexually transmitted diseases.
    Article · Aug 2016
    • "The prevalence of HSV-2 can therefore be thought of as a measure of the prevalence of non-STI-STE related risk factors in a population [6]. It is more useful in this regard than HIV as, unlike HIV, HSV-2's transmission/acquisition has not been shown to be enhanced by the presence of other STIs such as syphilis [7, 8] . The relationship between HIV, HSV- 2, syphilis, and their risk factors is illustrated inFigure 1. "
    Dataset · Mar 2016 · Epidemiology and Infection
    • "The prevalence of HSV-2 can therefore be thought of as a measure of the prevalence of non-STI-STE related risk factors in a population [6]. It is more useful in this regard than HIV as, unlike HIV, HSV-2's transmission/acquisition has not been shown to be enhanced by the presence of other STIs such as syphilis [7, 8] . The relationship between HIV, HSV- 2, syphilis, and their risk factors is illustrated inFigure 1. "
    [Show abstract] [Hide abstract] ABSTRACT: Syphilis is curable but Herpes Simplex Virus-2 (HSV-2) is not. As a result, the prevalence of syphilis but not HSV-2 may be influenced by the efficacy of national STI screening and treatment capacity. If the prevalence of syphilis and HSV-2 is found to be correlated, then this makes it more likely that something other than differential STI treatment is responsible for variations in the prevalence of both HSV-2 and syphilis. Methods. Simple linear regression was used to evaluate the relationship between national antenatal syphilis prevalence and HSV-2 prevalence in women in two time periods: 1990–1999 and 2008. Adjustments were performed for the laboratory syphilis testing algorithm used and the prevalence of circumcision. Results. The prevalence of syphilis was positively correlated with that of HSV-2 for both time periods (adjusted correlations, 20–24-year-olds: 1990–99: R 2 = 0.54 , P < 0.001 ; 2008: R 2 = 0.41 , P < 0.001 and 40–44-year-olds: 1990–99: R 2 = 0.42 , P < 0.001 ; 2008: R 2 = 0.49 , P < 0.001 ). Conclusion. The prevalence of syphilis and HSV-2 is positively correlated. This could be due to a common set of risk factors underpinning both STIs.
    Full-text · Article · Mar 2016
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