Effect of coinfection with STDs and of STD treatment on HIV shedding in genital-tract secretions

systematic review and data synthesis

Karen Rotchford, A. Willem Strum, David Wilkinson*

*Corresponding author for this work

Research output: Contribution to journalReview article

90 Citations (Scopus)

Abstract

Objective: To determine whether coinfection with sexually transmitted diseases (STD) increases HIV shedding in genital-tract secretions, and whether STD treatment reduces this shedding. Design: Systematic review and data synthesis of cross-sectional and cohort studies meeting predefined quality criteria. Main Outcome Measures: Proportion of patients with and without a STD who had detectable HIV in genital secretions, HIV load in genital secretions, or change following STD treatment. Results: Of 48 identified studies, three cross-sectional and three cohort studies were included. HIV was detected significantly more frequently in participants infected with Neisseria gonorrhoeae (125 of 309 participants, 41%) than in those without N gonorrhoeae infection (311 of 988 participants, 32%; P = 0.004). HIV was not significantly more frequently detected in persons infected with Chlamydia trachomatis (28 of 67 participants, 42%) than in those without C trachomatis infection (375 of 1149 participants, 33%; P = 0.13). Median HIV load reported in only one study was greater in men with urethritis (12.4 x 104 versus 1.51 x 104 copies/mi; P = 0.04). In the only cohort study in which this could be fully assessed, treatment of women with any STD reduced the proportion of those with detectable HIV from 39% to 29% (P = 0.05), whereas this proportion remained stable among controls (15-17%). A second cohort study reported fully on HIV load; among men with urethritis, viral load fell from 12.4 to 4.12 x 104 copies/ml 2 weeks posttreatment, whereas viral load remained stable in those without urethritis. Conclusion: Few high-quality studies were found. HIV is detected moderately more frequently in genital secretions of men and women with a STD, and HIV load is substantially increased among men with urethritis. Successful STD treatment reduces both of these parameters, but not to control levels. More high- quality studies are needed to explore this important relationship further.

Original languageEnglish
Pages (from-to)243-248
Number of pages6
JournalSexually Transmitted Diseases
Volume27
Issue number5
Publication statusPublished - May 2000
Externally publishedYes

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