From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection.
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It is suggested that timely provision of STD services can substantially reduce HIV incidence, but raise additional questions about the optimal way to target and implement these services to achieve the greatest effect on HIV transmission.Abstract:
Objectives: To review the scientific data on the role of sexually transmitted diseases (STDs) in sexual transmission of HIV infection and discuss the implications of these findings for HIV and STD prevention policy and practice Methods: Articles were selected from a review of Medline, accessed with the OVID search engine The search covered articles from January 1987 to September 1998 and yielded 2101 arti- cles Methods used to uncover articles which might have been missed included searching for related articles by author, and combing literature reviews In addition, all abstracts under the cat- egory "sexually transmitted diseases" from the XI and XII International Conferences on AIDS (Vancouver 1996 and Geneva 1998) and other relevant scientific meetings were reviewed Efforts were made to locate journal articles which resulted from the research reported in the identified abstracts All original journal articles and abstracts which met one of the following criteria were included: (1) studies of the biological plausibility or mechanism of facilitation of HIV infectious- ness or susceptibility by STDs, (2) prospective cohort studies (longitudinal or nested case-control) which estimate the risk of HIV infection associated with specific STDs or STD syndromes, or (3) intervention studies which quantitate the eVect which STD treatment can have on HIV incidence Results: Strong evidence indicates that both ulcerative and non-ulcerative STDs promote HIV transmission by augmenting HIV infectiousness and HIV susceptibility via a variety of biological mechanisms These eVects are reflected in the risk estimates found in numerous prospective studies from four continents which range from 20 to 235, with most clustering between 2 and 5 The relative importance of ulcerative and non-ulcerative STDs appears to be complex Owing to the greater frequency of non-ulcerative STDs in many populations, these infections may be responsible for more HIV transmission than genital ulcers However, the limited reciprocal impact of HIV infection on non-ulcerative STDs and the evidence that non-ulcerative STDs may increase risk primarily for the receptive partner (rather than bidirectionally) may modulate the impact of these diseases The results of two community level randomised, controlled intervention trials conducted in Africa suggest that timely provision of STD services can substantially reduce HIV incidence, but raise additional questions about the optimal way to target and implement these services to achieve the greatest eVect on HIV transmission Conclusions: Available data leave little doubt that other STDs facilitate HIV transmission through direct, biological mechanisms and that early STD treatment should be part of a high quality, comprehensive HIV prevention strategy Policy makers, HIV prevention programme managers, and providers should focus initial implementation eVorts on three key areas: (i) improving access to and quality of STD clinical services; (ii) promoting early and eVective STD related healthcare behaviours; and (iii) establishing surveillance systems to monitor STD and HIV trends and their interrelations (Sex Transm Inf 1999;75:3-17)read more
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References
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Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomised controlled trial
Heiner Grosskurth,Jim Todd,Ezra Mwijarubi,Philippe Mayaud,A. Nicoll,G Ka-Gina,J. Newell,Denise Mabey,Richard J. Hayes,Frank Mosha,Kesheni P. Senkoro,John Changalucha,Klokke Ah,Kokungoza Mugeye +13 more
TL;DR: It is concluded that improved STD treatment reduced HIV incidence by about 40% in this rural population of Tanzania, the first randomised trial to demonstrate an impact of a preventive intervention on HIV incidence in a general population.
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Epidemiological synergy. Interrelationships between human immunodeficiency virus infection and other sexually transmitted diseases.
TL;DR: Preliminary data from 83 reports on the impact of HIV infection on STDs suggest that, at a community level, HIV infection may increase the prevalence of some STDs (e.g., genital ulcerative and nonulcerative STDs), and if the same STDs facilitate transmission of HIV, these infections may greatly amplify one another.
Journal ArticleDOI
Non-ulcerative sexually transmitted diseases as risk factors for HIV-1 transmission in women: results from a cohort study.
Marie Laga,A.T. Manoka,M. Kivuvu,B. Malele,M. Tuliza,N Nzila,J Goeman,F Behets,Batter,Michel Alary +9 more
TL;DR: Non-ulcerative STD were risk factors for sexual transmission of HIV-1 in women, after controlling for sexual exposure, and offered an important additional strategy for the prevention of HIV/AIDS.
Journal ArticleDOI
Proportion of disease caused or prevented by a given exposure, trait or intervention
TL;DR: It is shown that both parameters depend—in different ways—on the frequency of the marker among cases of the disease, and on the "standardized morbidity ratio" for those with the marker.
Journal ArticleDOI
Reduction of concentration of HIV-1 in semen after treatment of urethritis: implications for prevention of sexual transmission of HIV-1
Myron S. Cohen,Irving F. Hoffman,Rachel A. Royce,Peter N. Kazembe,John R. Dyer,Celine Costello Daly,Dick Zimba,Pietro Vernazza,Martin Maida,Susan A. Fiscus,Joseph J. Eron +10 more
TL;DR: HIV-1-control programmes, which include detection and treatment of STDs in patients already infected with HIV-1, may help to curb the epidemic and targeting of gonococcal urethritis may be a particularly effective strategy.