[Viva] Fwd: CATIE News - High prevalence of sexually transmitted infections among people living with HIV - implications for HIV prevention

Thu Aug 25 21:40:15 PDT 2011

---------- Forwarded message ----------
From: <mailing at mercury.catie.ca>
Date: Tue, Aug 23, 2011 at 6:37 AM
Subject: CATIE News - High prevalence of sexually transmitted infections
among people living with HIV - implications for HIV prevention
To: cosmictami at shaw.ca

*CATIE News - High prevalence of sexually transmitted infections among
people living with HIV – implications for HIV prevention*

The sexual transmission of HIV occurs after an exposure to fluids that
contain HIV, such as semen, vaginal fluid or rectal fluid. Research shows a
higher amount of HIV (viral load) in these fluids increases the risk of HIV
transmission, while a lower amount of HIV decreases the risk of HIV
transmission.
Impact of STI co-infection on HIV transmission

Sexually transmitted infections (STIs)—such as gonorrhea, chlamydia, herpes
and syphilis—can increase the HIV viral load of a person who is co-infected
with HIV and an STI. Research shows that the location of the STI determines
which bodily fluid is affected. For example, a *rectal* STI can increase the
amount of HIV in the *rectal* fluid. Therefore, STI co-infection may
increase the risk of a person passing HIV to others through unprotected sex.

It is also well documented that HIV-negative individuals who have an STI are
at increased risk of becoming infected with HIV.

A recent systematic review explored the prevalence of STIs among people
living with HIV. The high prevalence of STI/HIV co-infection found in this
review has important implications for the transmission and prevention of
HIV.
Study details

The authors of the review searched for studies that reported the prevalence
of STIs among people living with HIV. The authors only included studies
reporting the prevalence of STIs that are known to increase HIV
transmission, including syphilis, chancroid, gonorrhea, chlamydia, herpes
(HSV-2), trichomoniasis, bacterial vaginosis, urethritis and cervicitis.

The search identified 37 studies, which were included in the review. Most of
the studies were from the United States and Europe. Nineteen of the 37
studies enrolled people living with HIV from North America. The studies
included a total of 708,296 people living with HIV. One study from New York
City accounted for approximately 90% of these individuals.
Results

Overall, an average of 16.3% of the people living with HIV were co-infected
with an STI. The average prevalence by type of STI was as follows:

   - Syphilis – 9.5%
   - Gonorrhea – 9.5%
   - Chlamydia – 5%
   - Trichomoniasis – 18.8%

STI rates were similar among men and women living with HIV.

STIs were more prevalent among individuals who were newly diagnosed with
HIV. The average prevalence of STI infection among those individuals who
learned of their positive HIV status when they were getting tested for STIs
was 19.6%.

There was no difference in the prevalence of STIs among individuals
receiving HIV treatment compared to those who were not on HIV treatment.

Only one Canadian study, published in 2009, was included in the review. This
study enrolled 455 men and 174 women from infectious disease clinics in
Edmonton, Quebec and Toronto. The prevalence of HIV/herpes co-infection
among participants was 54%. Of the people infected with herpes, 58% did not
have symptoms associated with herpes.
Implications for HIV prevention

The high prevalence of STIs among people living with HIV is concerning
because it may be facilitating the transmission of HIV. This systematic
review is a reminder that regular STI prevention counselling, testing (even
in the absence of symptoms) and treatment are important components of HIV
prevention.

The high prevalence of HIV/STI co-infection also has implications for
counselling people about the risk of HIV transmission. The risk factors for
the transmission of many STIs are not the same as those for HIV. Strategies
that some people may use to reduce their risk of HIV transmission, such as
serosorting, PrEP or treatment as prevention, may not reduce their risk of *
STI* transmission. If the use of these strategies leads to the transmission
of STIs, people may be inadvertently *increasing* the overall risk of HIV
transmission.
Implications for “treatment as prevention”

The authors of the review were particularly concerned about whether or not
the high prevalence of HIV/STI co-infection could undermine the
effectiveness of using “treatment as prevention” because of an increased
risk of HIV transmission in the presence of another STI.

People using HIV “treatment as prevention” may feel a false sense of
security and engage in more risky behaviours—such as using fewer condoms or
increasing their number of partners. This is also known as risk
compensation. Risk compensation is a concern because HIV treatment does not
completely eliminate the risk of transmitting HIV or reduce the risk of
becoming infected with an STI. Therefore, risk compensation may further
increase the prevalence of HIV/STI co-infection and reduce the effectiveness
of “treatment as prevention.”

The authors suggest that all individuals who are using HIV treatment to
reduce their risk of transmitting HIV should “receive routine STI screening
every three to four months” and “repeated counselling to address erroneous
beliefs regarding infectiousness.” Counselling should include discussing the
importance of condom use in reducing both HIV and STI transmission.

—James Wilton

*References*

   1. Johnson LF, Lewis DA. The effect of genital tract infections on HIV-1
   shedding in the genital tract: a systematic review and
meta-analysis. *Sexually
   Transmitted Diseases*. 2008 Nov;35(11):946-59.
   2. Kalichman S, Pellowski J, Turner C. Prevalence of sexually transmitted
   co-infections in people living with HIV/AIDS: systematic review with
   implications for using HIV treatments for prevention. *Sexually
   Transmitted Infections.* 2011 Apr;87(3):183-90.

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-- 
Meegwetch/Thank you/Merci
*Tami M. Starlight*
Vancouver, Canada
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