Genital ulceration does not increase HIV-1 shedding in cervical or vaginal secretions of women taking antiretroviral therapy

Graham, Susan M.; Masese, Linnet; Gitau, Ruth; Richardson, Barbra A.; Mandaliya, Kishor; Peshu, Norbert; Jaoko, Walter; Ndinya‐Achola, Jeckoniah; Overbaugh, Julie; McClelland, R. Scott

doi:10.1136/sti.2010.045369

Cited by 6 publications

(7 citation statements)

References 15 publications

(16 reference statements)

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“…The results presented here parallel those from recently published data from the same cohort assessing the impact of cervical infections [21] and genital ulcer disease (GUD) on genital HIV-1 shedding [22]. In the cervicitis study, HIV-1 RNA was detected in cervical secretions of 30 women before, during, and after cervicitis at one (3.2%), five (16.1%), and three (9.7%) visits, respectively.…”

Section: Discussionsupporting

confidence: 84%

A prospective study of vaginal trichomoniasis and HIV-1 shedding in women on antiretroviral therapy

et al. 2011

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BackgroundTrichomonas vaginalis has been associated with increased vaginal HIV-1 RNA shedding in antiretroviral therapy (ART)-naïve women. The effect of trichomoniasis on vaginal HIV-1 shedding in ART-treated women has not been characterized. We tested the hypothesis that T. vaginalis infection would increase vaginal HIV-1 RNA shedding in women on ART, and that successful treatment would reduce vaginal HIV-1 RNA levels.MethodsWe conducted a prospective cohort study including monthly follow-up of 147 women receiving ART in Mombasa, Kenya. Those with T. vaginalis infection, defined by the presence of motile trichomonads on vaginal saline wet mount, received treatment with single dose metronidazole (2 g). Test of cure was performed at the next monthly visit. Using the pre-infection visit as the reference category, we compared detection of vaginal HIV-1 RNA before versus during and after infection using generalized estimating equations. A cut-off of 100 HIV-1 RNA copies/swab was used as the lower limit for linear quantitation.ResultsAmong 31 women treated for trichomoniasis, the concentration of vaginal HIV-1 RNA was above the limit for quantitation before, during, and after T. vaginalis infection in 4 (13% [95% CI 4% - 30%]), 4 (13% [95% CI 4% - 30%]), and 5 (16% [95% confidence interval {CI} 5% - 34%]) women respectively. After adjusting for potential confounding factors, we could detect no difference in the likelihood of detecting vaginal HIV-1 RNA before versus during infection (odds ratio [OR] 1.41, 95% CI 0.23 - 8.79, p = 0.7). In addition, detection of HIV-1 RNA was similar before infection versus after successful treatment (OR 0.68, 95% CI (0.13 - 3.45), p = 0.6).ConclusionDetection of vaginal HIV-1 RNA during ART was uncommon at visits before, during and after T. vaginalis infection.

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Section: Discussionsupporting

confidence: 84%

A prospective study of vaginal trichomoniasis and HIV-1 shedding in women on antiretroviral therapy

et al. 2011

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“…Hence our findings are limited to an indirect measurement of HIV-infectiousness as measured by viral load at various anatomical sites. Of these 14 studies, two studies included participants from resource-limited countries [ 31 , 34 ]; four studies focused on MSM [ 35 – 38 ]; and two reported on ART adherence [ 34 , 40 ]. Syphilis, chlamydia and gonorrhea were the most reported STIs in the eligible studies.…”

Section: Resultsmentioning

confidence: 99%

“…The more STIs tested, the smaller the risk of incorrectly categorizing individuals as mono-infected. Six studies [ 32 – 34 , 37 , 39 , 40 ] out of 14 reported on testing more than 4 STIs (in addition to HIV). Reporting adherence to ART reduces statistical misattribution of the reasons for increases in HIV viral load.…”

Section: Resultsmentioning

confidence: 99%

“…Reporting adherence to ART reduces statistical misattribution of the reasons for increases in HIV viral load. Three studies [ 20 , 34 , 41 ] out of 14 explicitly reported adherence to ART. Because of HIV compartmentalization [ 42 ] (viral concentration may substantially differ between different anatomical sites within the same individual at a given time), measuring HIV viral load in genital or anal secretions is most relevant when considering sexual transmission.…”

Section: Resultsmentioning

confidence: 99%

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The effect of sexually transmitted co-infections on HIV viral load amongst individuals on antiretroviral therapy: a systematic review and meta-analysis

et al. 2015

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BackgroundAntiretroviral therapy (ART) markedly reduces HIV transmission, and testing and treatment programs have been advocated as a method for decreasing transmission at the population level. Little is known, however, about the extent to which sexually transmitted infections (STIs), which increase the HIV infectiousness of untreated individuals, may decrease the effectiveness of treatment as prevention.MethodsWe searched major bibliographic databases to August 12th, 2014 and identified studies reporting differences in HIV transmission rate or in viral load between individuals on ART who either were or were not co-infected with another STI. We used hierarchical Bayesian models to estimate viral load differences between individuals with and without STI co-infections.ResultsThe search strategy retrieved 1630 unique citations of which 14 studies (reporting on 4607 HIV viral load measurements from 2835 unique individuals) met the inclusion criteria. We did not find any suitable studies that estimated transmission rates directly in both groups. Our meta-analysis of HIV viral load measurements among treated individuals did not find a statistically significant effect of STI co-infection; viral loads were, on average, 0.11 log10 (95 % CI −0.62 to 0.83) higher among co-infected versus non-co-infected individuals.ConclusionsDirect evidence about the effects of STI co-infection on transmission from individuals on ART is very limited. Available data suggests that the average effect of STI co-infection on HIV viral load in individuals on ART is less than 1 log10 difference, and thus unlikely to decrease the effectiveness of treatment as prevention. However, there is not enough data to rule out the possibility that particular STIs pose a larger threat.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-0961-5) contains supplementary material, which is available to authorized users.

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“…There are a large series of reports of detection of HIV virus in the female genital tract with a wide variety of STIs . Graham and colleagues sought to understand how genital ulceration impacted cervical and vaginal shedding of HIV‐1 in women receiving ART in Kenya . Among 145 women who initiated ART, 36 developed a genital ulcer after at least two months of ART; ten women (28%) had detectable HIV‐1 RNA in their genital secretions.…”

Section: Discussionmentioning

confidence: 99%

Sexually transmitted infections and HIV in the era of antiretroviral treatment and prevention: the biologic basis for epidemiologic synergy

2019

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Introduction HIV is a unique sexually transmitted infection (STI) that is greatly affected by other concomitant “classical” bacterial and viral STIs that cause genital ulcers and/or mucosal inflammation. STIs also serve as a marker for risky sexual behaviours. STIs increase infectiousness of people living with HIV by increasing the viral concentration in the genital tract, and by increasing the potential for HIV acquisition in people at risk for HIV. In addition, some STIs can increase blood HIV concentration and promote progression of disease. This review is designed to investigate the complex relationship between HIV and classical STIs. Discussion Treatment of STIs with appropriate antibiotics reduces HIV in blood, semen and female genital secretions. However, community‐based trials could not reliably reduce the spread of HIV by mass treatment of STIs. Introduction of antiretroviral agents for the treatment and prevention of HIV has led to renewed interest in the complex relationship between STIs and HIV. Antiretroviral treatment (ART) reduces the infectiousness of HIV and virtually eliminates the transmission of HIV in spite of concomitant or acquired STIs. However, while ART interrupts HIV transmission, it does not stop intermittent shedding of HIV in genital secretions. Such shedding of HIV is increased by STIs, although the viral copies are not likely replication competent or infectious. Pre‐exposure prophylaxis (PrEP) of HIV with the combination of tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) prevents HIV acquisition in spite of concomitant STIs. Conclusions STIs remain pandemic, and the availability of ART may have led to an increase in STIs, as fear of HIV has diminished. Classical STIs present a huge worldwide health burden that cannot be separated from HIV, and they deserve far more attention than they currently receive.

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Genital ulceration does not increase HIV-1 shedding in cervical or vaginal secretions of women taking antiretroviral therapy

Cited by 6 publications

References 15 publications

A prospective study of vaginal trichomoniasis and HIV-1 shedding in women on antiretroviral therapy

A prospective study of vaginal trichomoniasis and HIV-1 shedding in women on antiretroviral therapy

The effect of sexually transmitted co-infections on HIV viral load amongst individuals on antiretroviral therapy: a systematic review and meta-analysis

Sexually transmitted infections and HIV in the era of antiretroviral treatment and prevention: the biologic basis for epidemiologic synergy

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