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

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...

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Published in:Journal of the International AIDS Society Vol. 22; no. S6; pp. e25355 - n/a
Main Authors: Cohen, Myron S, Council, Olivia D, Chen, Jane S
Format: Journal Article
Language:English
Published: Switzerland John Wiley & Sons, Inc 01.08.2019
John Wiley and Sons Inc
Subjects:
Acquired immune deficiency syndrome
acquisition
AIDS
Antibiotics
Antiretroviral agents
Antiretroviral drugs
Antiviral agents
Blood
Condoms
Disease transmission
Dosage and administration
Drug therapy
HIV
HIV infection
Human immunodeficiency virus
Infections
Inflammation
Mens health
Pandemics
PrEP
Prevention
Prophylaxis
Review
Risk factors
Sexual behavior
Sexually transmitted diseases
shedding
STD
STI
transmission
Ulcers
Viral infections
Viruses
United States
STD
ART
transmission
HIV
STI
shedding
PrEP
acquisition
ISSN:1758-2652, 1758-2652
Online Access:Get full text
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Summary: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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ISSN:1758-2652
1758-2652
DOI:10.1002/jia2.25355