The Effect of Genital Tract Infections on HIV-1 Shedding in the Genital Tract: A Systematic Review and Meta-Analysis

Abstract

This article reviews the effect of genital tract infections and associated clinical conditions on the detection and concentration of HIV-1 shedding in the genital tract. A search of the PubMed, Embase, and AIDSearch databases was conducted. Meta-analysis was performed on those studies that reported the effect of genital tract infections on the detection of HIV-1 shedding. Thirty-nine studies met the inclusion criteria. The odds of HIV-1 detection in the genital tract were increased most substantially by urethritis (OR 3.1, 95% CI: 1.1-8.6) and cervicitis (OR 2.7, 95% CI: 1.4-5.2). The odds of HIV-1 detection were also increased significantly in the presence of cervical discharge or mucopus (OR 1.8, 95% CI: 1.2-2.7), gonorrhoea (OR 1.8, 95% CI: 1.2-2.7), chlamydial infection (OR 1.8, 95% CI: 1.1-3.1), and vulvovaginal candidiasis (OR 1.8, 95% CI: 1.3-2.4). Other infections and clinical conditions were found to have no significant effect on the detection of HIV-1, although HSV-2 shedding was found to increase the concentration of HIV-1 shedding, and genital ulcer disease was found to increase the odds of HIV-1 detection significantly after excluding one biased study (OR 2.4, 95% CI: 1.2-4.9). This analysis shows that infections that are associated with significant increases in leukocyte concentrations in the genital tract are also associated with significant increases in HIV-1 shedding. These infections are likely to be particularly important in promoting the sexual transmission and mother-to-child intrapartum transmission of HIV-1, and should therefore be the focus of HIV prevention strategies.

review of the control of schistosomiasis in South Africa

“…CD4 cells are the receptors used by HIV to enter the host cells and a high concentration of CD4 cells is contained in the egg granulomas and the adjacent areas. 13 It has further been hypothesised that women co-infected with HIV and S. haematobium infection may transmit HIV to their partners more easily than HIV-infected women without S. haematobium infection. 4 Leukocytes may harbour HIV and conditions that result in recruitment of leukocytes to the genital tract, for example genital ulcer disease or S. haematobium infection, may result in an increase in viral shedding of HIV into the female genital tract.…”

“…4 Leukocytes may harbour HIV and conditions that result in recruitment of leukocytes to the genital tract, for example genital ulcer disease or S. haematobium infection, may result in an increase in viral shedding of HIV into the female genital tract. 13 …”

“…8,13 Increased susceptibility may be because of an influx of immune cells but could also be because of breaches in the integrity of the mucosal barrier of the vagina and the cervix. Similarly, female genital schistosomiasis has been hypothesised to increase HIV susceptibility of women.…”

Normal flora and bacterial vaginosis in pregnancy: an overview

“…Bacterial vaginosis enhances viral replication and BV-related bacteria directly up-regulate the replication of HIV through a heat-stable HIV-inducing factor Johnson and Lewis, 2008). Vaginal shedding of HIV is propagated by BV and women who are affected by both HIV and BV can shed virus particles up to six times more versus those who are BV negative (Coleman et al, 2007;Taha et al, 1998).…”

Intervention programmes for HIV and AIDS prevention: a study of in- school adolescents in Orlu Senatorial Zone of Imo State, Nigeria

“…14,15 Currently, adequate information on strategies to increase HIV risk reduction behaviours and attitudes among adolescents is limited in developing countries including Nigeria. [16][17][18][19] The most important is the inability to highlight interventions capable of communicating adequate knowledge and attitudes that will prevent adolescents especially those living with HIV and AID from infections with other strands of HIV. 20,21 Apart from the occasional HIV and AIDS messages given by some health workers and teachers, organized interventions such as classroom-based teaching and drama have not been effectively utilized.…”