IDSA Report: Coverage of 2004 IDSA Meeting

HIV affects STD rates, Kenya research shows

Study looked at women in Kenya

Research often has looked at the way sexually transmitted diseases (STDs) increase the risk of people acquiring HIV, but few have examined the reverse: whether HIV infection increases the risk of acquiring STD.

A recent study took that perspective and found that infection with HIV-1 was associated with a higher incidence of genital ulcer disease, gonorrhea, and vulvovaginal candidiasis, after adjusting for potential confounding factors, says R. Scott McClelland, MD, MPH, an assistant professor of medicine and epidemiology at the University of Washington in Seattle. The study was presented at the 2004 annual meeting of the Infectious Diseases Society of America, held Sept. 30 to Oct. 3, 2004, in Boston.

Investigators collected data from a prospective cohort of female sex workers in Mombasa, Kenya, between 1993 and 2003. HIV-seronegative women were tested monthly for HIV and STDs. Altogether, 238 out of 1,215 women seroconverted to HIV-1 during follow-ups. HIV-positive and -negative women’s incidence of genital tract infections were compared.1

The study concluded that increased incidence of genital tract infections among HIV-1 positive women could promote the spread of HIV and other STDs.1

The study’s focus was intentionally different from most of the literature that examines co-infected individuals, he explains.

"While there are many studies that have looked at the impact of genital tract infections on the risk for acquiring HIV, there are far fewer studies that have examined the effect of HIV on the risk for acquiring genital tract infections," McClelland says. "Both components of this bi-directional interaction could contribute to the spread of HIV and other sexually transmitted diseases."

The study’s findings are particularly applicable to programs and policies regarding screening and treatment for STDs in high-risk populations as a component of HIV prevention, he says.

"For individual patients, there does appear to be a modest increase in the risk of genital ulcer, vaginitis, and gonorrhea," McClelland notes. "But the study wasn’t designed to make recommendations about whether individual patients should be screened."

Screening would be challenging in resource-limited settings where the health care dollars are earmarked, he says.

"The question arises as to what interventions may be the most important for decreasing the spread of HIV, and one intervention in place is for programs aimed at diagnosis and treatment of sexually transmitted diseases," McClelland explains.

"A greater focus recently has been on anti-retroviral therapy, and while that’s important for patients with more advanced disease, many who are HIV-positive will not qualify for that," he says. "So continuing to maintain the programs aimed at prevention of HIV as we scale up treatment programs will be critically important for continuing to prevent the more rapid spread of HIV."

It comes down to money

It comes down to the limited money available and how it best can be spent, he says.

"We’re facing the same issues in our own clinic where we were introducing antiretroviral therapy in the last year, and in the context of doing that we’re trying to step up and maintain efforts to control prevention services as well," McClelland continues. "I think, in some settings, that can be lost."

In a clinic that has served as a prevention research cohort for 11 years, as is the case with the clinic in Mombasa, Kenya, it’s not very difficult to maintain prevention efforts, he notes.

"However, prevention is something that can be lost in a clinic that begins to focus more on finding patients with the most advanced disease and puts all resources on treatment," McClelland says.

The study’s other main message is that it’s important to continue to screen for STD infections among HIV-positive individuals, he says.

"We continue to stress STD screening as an important intervention for preventing HIV transmission," McClelland adds.

Reference

1. McClelland RS, Lavreys L, Katingima C, et al. Contribution of HIV-1 infection to STD acquisition: A ten-year prospective study. Presented at the 2004 annual meeting of the IDSA. Boston; October 2004. Poster: 797.