Metaanalysis and Metaregression in Interpreting Study Variability in the Impact of Sexually Transmitted Diseases on Susceptibility to HIV Infection
GLOBINF--Centre for Prevention of Global Infections, University of Oslo, Oslo, Norway. Sex Transm Dis
(Impact Factor: 2.84).
07/2005; 32(6):351-7. DOI: 10.1097/01.olq.0000154504.54686.d1
Observational studies examining the effects of other sexually transmitted diseases (STDs) on HIV susceptibility differ in the populations observed and in which "other STDs" are examined. The extent to which an STD alters the risk of transmission of HIV may vary according to disease and population characteristics.
The goals of this study were to review studies examining the effect of other STDs on HIV-1 susceptibility and to correlate their effect estimates with type of "other STD", study design, and population characteristics.
Relevant studies with longitudinal design were identified through a systematic search of the PubMed database, and their evidence was critically evaluated. Metaregression techniques were then used to correlate study characteristics with corresponding effect estimates.
Of 31 studies included, 4 contained direct data on exposure to HIV-1. Three of these were inconclusive, the fourth indicating a strong relationship between STDs and transmission of HIV. Pooled effect estimates using all studies are statistically significant and indicate a 2- to 3-fold increase in risk of HIV-1 acquisition. Effect estimates corresponding some of the "other STD" categories exhibit heterogeneity, but no significant associations with study characteristics were found.
Most of the studies lack direct exposure data, lending them susceptible to exposure bias. Another problem may be measurement error about risk factors and STD status at time of HIV-1 infection. Because direct exposure data are difficult to come by (4 of 31 studies contained such data, all but 1 inconclusive), future observational studies on the influence of STDs on HIV-1 transmission should include quantitative analyses of the sensitivity of results to potential confounding and measurement error if they are to further understanding.
Available from: Ameeta E Singh
- "In 2010, the number of cases of infectious syphilis reported in Alberta and in Edmonton declined and continued to decrease to a reported rate of 3.2 per 100,000 in the Edmonton area in 2011 . The return of infectious syphilis in Alberta has the potential to impact HIV control as individuals with syphilis have an estimated two-to-five fold increased risk of acquiring HIV . Additionally, HIV positive individuals may be more "
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ABSTRACT: Few studies have evaluated the feasibility of delivering syphilis point-of-care (POC) testing in outreach (nonclinical) settings in resource rich countries. The objectives of the study were to evaluate the feasibility and diagnostic performance of performing both HIV and syphilis POC testing in outreach settings and to document new cases identified in the study population. 1,265 outreach testing visits were offered syphilis and HIV POC testing and 81.5% (n = 1,031) consented to testing. In our population, the SD Bioline 3.0 Syphilis Test had a sensitivity of 85.3% [CI (68.9-95.0)], specificity of 100.0% [CI (99.6-100.0)], positive predictive value (PPV) of 100.0% [CI (88.1-100.0)], and negative predictive value (NPV) of 99.5% [CI (98.9-99.8)]. Test characteristics for the INSTI HIV-1/HIV-2 Antibody Test had a 100.0% sensitivity [CI (39.8-100.00], 99.8 specificity [CI (99.3-100)], 66.7% PPV [CI (22.3-95.7)], and 100.0% NPV [CI (99.6-100.0)]. Four new cases of syphilis and four new HIV cases were diagnosed. In summary, at risk population seeking STI testing found POC tests to be acceptable, the POC tests performed well in outreach settings, and new cases of syphilis and HIV were identified and linked to treatment and care.
Available from: Leigh Johnson
- "It is important to assess the extent to which this high HIV prevalence is explained by different biomedical and behavioural factors. Sexually transmitted infections (STIs) have been hypothesized to play a major role in the spread of HIV, with observational studies showing that HIV-negative individuals with STIs are more susceptible to HIV than STI-uninfected individuals (Røttingen et al. 2001; Sexton et al. 2005). Observational studies have also demonstrated that HIV-infected individuals who are coinfected with STIs have increased levels of HIV in their genital tracts, rendering them more likely to transmit HIV (Johnson & Lewis 2008). "
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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.
Available from: Ina U Park
- "Anal HPV infection may also have public health implications beyond anal cancer because recent data have demonstrated that infection with multiple HPV types is independently associated with acquisition of HIV infection among MSM [45•]. A link between sexually transmitted infections and increased susceptibility to HIV infection has been established over the past decade; however, interventions to treat or prevent sexually transmitted infections to reduce HIV acquisition have generally been disappointing . The possible role that anal HPV infection might play in HIV acquisition certainly warrants further investigation, especially given the availability of a highly efficacious vaccine against HPV infection. "
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ABSTRACT: The incidence of human papillomavirus (HPV)-associated anal cancer in men who have sex with men (MSM) is striking and has not been mitigated by the use of highly active antiretroviral therapy. Detection and treatment of high-grade anal intraepithelial neoplasia (HGAIN) may reduce the incidence of anal cancer. Anal cytology is a useful tool to detect HGAIN; annual screening of HIV-positive MSM and biennial screening of HIV-negative MSM appears to be cost-effective. MSM with abnormal cytology should be referred for high-resolution anoscopy and biopsy. Individuals with HGAIN should receive treatment; treatment modalities for HGAIN demonstrate moderate efficacy and are usually well tolerated, but greater study is required to determine which treatment is optimal. Large prospective studies are needed to document the efficacy of screening and treatment of HGAIN on anal cancer incidence. The HPV vaccine holds promise for primary prevention of anal cancer in MSM, but significant implementation challenges remain.
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