Antiretroviral therapy suppresses rectal HIV-RNA shedding despite inflammation in MSM with rectal <i>C. trachomatis</i> and <i>N. gonorrhoeae</i> infections—a cross-sectional, single-center study

Storim, Julian; Verheyen, Jens; Wolff, Eva; Wohlschlaeger, Jeremias; Heinegg, Evelyn Heintschel von; Schadendorf, Dirk; Eßer, Stefan

doi:10.1136/sextrans-2017-053409

Cited by 6 publications

(5 citation statements)

References 11 publications

(5 reference statements)

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“…5,6 Genital inflammation increases both HIV transmission and acquisition, 7 including clinically diagnosed STI and sub-clinical inflammation. 5,8 Specifically, genital 9,10 and rectal 11 inflammation increase HIV transmission, with the role of STI in HIV transmission diminished by antiretroviral therapy (ART) and HIV suppression. 12 While ART reduces the effects of co-occurring STI on HIV transmission, HIV transmission remains high when ART adherence is incomplete, viral suppression is not sustained, and genital inflammation is present.…”

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confidence: 99%

Undetected anogenital sexually transmitted infections among young adults living with HIV and receiving antiretroviral therapy: Implications for HIV treatment as prevention

2021

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Undetected sexually transmitted infections (STIs) pose health threats to people living with HIV and when combined with uncontrolled HIV can amplify HIV transmission. The current study screened 174 self-identified men under age 36 living with HIV and receiving antiretroviral therapy (ART) for urethral and rectal incident chlamydia and gonorrhea infections. Participants were also screened for biomarkers indicating alcohol and other drug use, subclinical genital inflammation, and HIV viral load. ART adherence and sexual behaviors were also assessed prospectively over 1 month. Results detected an undiagnosed STI in 32 (18%) individuals. Participants with a previously undetected STI had significantly greater HIV viremia than those who did not have an STI after controlling for several confounding variables. Participants with an undetected STI also engaged in greater condomless anal intercourse with HIV negative and unknown status partners, including partners to whom they had not disclosed their HIV status. These findings show that undetected STI are associated with incomplete ART adherence and unsuppressed HIV, all of which are important for preventing HIV transmission.

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confidence: 99%

Undetected anogenital sexually transmitted infections among young adults living with HIV and receiving antiretroviral therapy: Implications for HIV treatment as prevention

2021

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“…Some limitations identified in this study included the absence of HIV RNA data from HIV-positive participants who did not accept immediate ART and did not have samples collected at 12 and 24 months after baseline. We found that 62% to 65% of MSM in our study had detectable anogenital HIV RNA at baseline which was in the range of 57% to 100% previously reported among men not on ART [26][27][28][29]. However, differences in anogenital sampling and HIV RNA measurement techniques which could affect the detection rate of HIV RNA in these compartments imply that direct comparisons of data between studies may not be simply made [27,28].…”

Section: Discussionmentioning

confidence: 60%

Sexually transmitted infections and HIV RNA levels in blood and anogenital compartments among Thai men who have sex with men before and after antiretroviral therapy: implication for Treatment as Prevention programme

et al. 2018

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IntroductionSexually transmitted infections (STIs) are common among HIV‐positive men who have sex with men (MSM). There have been concerns that undiagnosed and untreated STIs could undermine efforts to use antiretroviral therapy (ART) for prevention due to genital secretion infectiousness. We evaluated the correlation between STIs and HIV RNA in anogenital compartments among HIV‐positive MSM before and after ART.MethodsMSM participants newly diagnosed with HIV were offered ART regardless of CD4 count during November 2012 to November 2015. Syphilis serology, oropharyngeal swab, rectal swab, urine collection for gonorrhoea and chlamydia nucleic acid amplification testing, and HIV RNA measurement in blood, semen and rectal samples were performed at baseline, 12 and 24 months thereafter.ResultsOf 143 HIV‐positive MSM, 16.1% had syphilis, 23.1% had gonorrhoea and 32.8% had chlamydia at baseline. Participants with STIs at baseline had higher median HIV RNA levels in blood plasma (p = 0.053), seminal plasma (p = 0.01) and rectal secretions (p = 0.002) than those without STIs. Multivariate models identified HIV RNA 100,000 to 500,000 (OR 6.74, 95% CI 2.24 to 20.28, p = 0.001) and >500,000 (OR 9.39, 95% CI 1.08 to 81.72, p = 0.04) copies/mL in blood, CD4 count <350 cells/mm3 (OR 4.20, 95% CI 1.05 to 16.70, p = 0.04) and having any STIs (OR 2.62, 95% CI 1.01 to 6.80 p = 0.047) to be associated with detectable (>40 copies/mL) seminal plasma HIV RNA. Having chlamydia at any sites (OR 3.17, 95% CI 1.07 to 9.44, p = 0.04) was associated with detectable rectal HIV RNA. Incidences of syphilis, gonorrhoea and chlamydia were 13.4, 16.4 and 18.1 per 100 person‐years respectively. Nine participants had detectable HIV RNA (five in blood, one in semen, two in rectal samples and one in both blood and rectal samples) at 12 and/or 24 months after ART.ConclusionsSTIs were extremely common among HIV‐positive MSM prior to and after ART. ART effectively reduced HIV RNA in all compartments. The correlation between STIs and anogenital HIV RNA, especially prior to ART and likely until complete HIV RNA suppression from ART is achieved, points to the importance of integrating asymptomatic STIs screening into Treatment as Prevention programme for MSM.

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“…STI screening was not conducted in all participants but only in those symptomatic and that may partially explain the relatively low STI prevalence we identified compared with other similar populations [19] and this may also limit the generalizability of the findings. However, recent data suggest that rectal bacterial STIs are not associated with HIV shedding in patients effectively suppressed on ART [20]. Furthermore, in the PIVOT trial, the initial rate of viral rebound on PI-mono was high (32%).…”

Section: Discussionmentioning

confidence: 99%

Genital Secretion HIV RNA Shedding in HIV-Positive Patients on Ritonavir-Boosted Protease Inhibitor Monotherapy or Standard Combination ART: A Cross-Sectional Sub-Study from the PIVOT Trial

Arenas‐Pinto¹,

Stöhr

Khoo

et al. 2020

Antiviral Therapy

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Antiretroviral therapy suppresses rectal HIV-RNA shedding despite inflammation in MSM with rectal C. trachomatis and N. gonorrhoeae infections—a cross-sectional, single-center study

Abstract: UTN: U1111-1150-4804. German Clinical Trials Register (DRKS): DRKS00005468.

Cited by 6 publications

References 11 publications

Undetected anogenital sexually transmitted infections among young adults living with HIV and receiving antiretroviral therapy: Implications for HIV treatment as prevention

Undetected anogenital sexually transmitted infections among young adults living with HIV and receiving antiretroviral therapy: Implications for HIV treatment as prevention

Sexually transmitted infections and HIV RNA levels in blood and anogenital compartments among Thai men who have sex with men before and after antiretroviral therapy: implication for Treatment as Prevention programme

Genital Secretion HIV RNA Shedding in HIV-Positive Patients on Ritonavir-Boosted Protease Inhibitor Monotherapy or Standard Combination ART: A Cross-Sectional Sub-Study from the PIVOT Trial

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