Study shows STDs increase risk of HIV
Study shows STDs increase risk of HIV
Antibiotic treatment lowers infection rate
Researchers have found that HIV-positive patients treated with antibiotics for gonorrhea and other sexually transmitted diseases have lower levels of HIV in their semen, resulting in reduced risk for transmitting the virus. The study emphasizes the relationship between HIV and other STDs, and underscores the importance of STD treatment as an HIV prevention tool, health officials note.
The study was conducted in the southern Africa country of Malawi, where as much as 15% of the adult population is infected with HIV. Lead by Myron Cohen, MD, an AIDS researcher at the University of North Carolina (UNC) in Chapel Hill, the study was published in the July 28 issue of Lancet.
"This is a very important finding, because it is the first one to give the biological evidence of what we in epidemiology have observed: Sexually transmitted infections have an impact on the probability of acquiring and transmitting HIV," says Rachel Royce, MD, an epidemiologist and associate of Cohen’s at UNC.
A biological common denominator of STDs and HIV is seminal fluid. The semen of men infected with both pathogens carries the virus and the venereal microbes. Yet, the role of gonorrhea and the other STDs in expediting the transmission of HIV is only now coming into focus. In a UNC statement, Cohen observed that "the more virus in semen, the greater the chance for transmission to someone else. We believe this is more efficient in sub-Saharan Africa and some other areas, because STDs are more prevalent there, and therefore more HIV is transmitted during sex."
Preventing HIV by treating STDs
The findings have public health implications for the United States as well, says Anthony Fauci, MD, MPH, director of the National Institute for Allergy and Infectious Diseases. By treating a sexually transmitted disease with inexpensive antibiotics, clinicians may also be preventing HIV infections, which are considerably more costly to treat, he notes.
Royce also points out that the Malawi findings have important payoffs on the American scene. "The transmission of HIV today by same-sex sex is not what’s currently infecting the major group of people," she notes. "Having an STD can affect any human being regardless of whom they have sex with men with men or men with women."
Moreover, Royce points out, "We have a surge of STD going on in the Southern U.S., which is where the HIV epidemic is currently moving the fastest. The South is where there is an excess of gonorrhea and syphilis, compared to the rest of the nation."
At the STD clinic in Malawi’s capital city of Lilongwe early last year, a mixed team, primarily UNC and Malawi specialists, recruited 86 young male patients infected with HIV-1. Two-thirds of them also had gonorrhea; the rest had chlamydia and trichomonas STD. Another 40 HIV-positive men and 127 HIV-negatives served as controls.
The volunteers donated samples of their semen. Then, all the STD-positive men, identified by their urethritis, received a course of the antibiotic gentamicin, which cleared up their venereal diseases in two weeks. Pre- and post-antibiotic semen specimens revealed that HIV-positive men with concomitant STD urethritis had eight times higher concentrations of viral RNA in their semen than did HIV-positives without the venereal urethritis. Yet, both virus-infected cohorts had similar CD4 counts and concentrations.
The HIV titers in semen dropped sharply after antimicrobial therapy dispelled their STD urethritis. Gonorrhea, by far the most prevalent STD in Malawi, led this drop in seminal virus RNA. The authors of the study conclude with a strong take-home message: ". . . the diagnosis and treatment of STDs, especially gonorrhea, in patients with HIV infection, should be a key component of HIV prevention programs."
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