Abstract
Due to shared routes of infection, HIV-infected persons are frequently coinfected with other sexually transmitted infections (STIs). Studies have demonstrated the bidirectional relationships between HIV and several STIs, including herpes simplex virus-2 (HSV-2), hepatitis B and C viruses, human papilloma virus, syphilis, gonorrhea, chlamydia, and trichomonas. HIV-1 may affect the clinical presentation, treatment outcome, and progression of STIs, such as syphilis, HSV-2, and hepatitis B and C viruses. Likewise, the presence of an STI may increase both genital and plasma HIV-1 RNA levels, enhancing the transmissibility of HIV-1, with important public health implications. Regarding the effect of STIs on HIV-1 progression, the most studied interrelationship has been with HIV-1/HSV-2 coinfection, with recent studies showing that antiherpetic medications slow the time to CD4 <200 cells/µL and antiretroviral therapy among coinfected patients. The impact of other chronic STIs (hepatitis B and C) on HIV-1 progression requires further study, but some studies have shown increased mortality rates. Treatable, nonchronic STIs (i.e., syphilis, gonorrhea, chlamydia, and trichomonas) typically have no or transient impacts on plasma HIV RNA levels that resolve with antimicrobial therapy; no long-term effects on outcomes have been shown. Future studies are advocated to continue investigating the complex interplay between HIV-1 and other STIs.
Highlights
Individuals infected with human immunodeficiency virus-1 (HIV-1) are often coinfected with other sexually transmitted infections (STIs) due to shared routes of transmission
Some studies evaluating CD4 cell count responses in coinfected individuals after antiretroviral therapy (ART) found no differences in CD4 gains in HIV-1/Hepatitis B virus (HBV) coinfected versus HIV-1 monoinfected individuals [54, 57, 69], while other studies have shown a negative impact of HBV on CD4 cell count recovery
While the impact of HIV-1 infection on the clinical presentations and treatment outcomes of STIs is well known, fewer data exist regarding the impact of concurrent STIs on HIV-1 progression and acquisition, with most studies focusing on HIV1 shedding at genital mucosal sites
Summary
Individuals infected with human immunodeficiency virus-1 (HIV-1) are often coinfected with other sexually transmitted infections (STIs) due to shared routes of transmission. There has been mounting evidence of the bidirectional relationship between HIV-1 and other STIs. Initially, studies showed that HIV-1-infected persons may be at risk for more frequent and severe forms of STIs as well as poorer treatment outcomes, especially in cases of concurrent herpes simplex virus-2 (HSV-2) and syphilis infection. More recent data have demonstrated that certain concomitant STIs directly affect HIV-1 transmissibility and may alter HIV1 control and increase progression to AIDS. This review summarizes the current literature regarding the most common STIs (HSV-2, hepatitis B virus, hepatitis C virus, human papilloma virus, syphilis, gonorrhea, chlamydia, and trichomonas) and their impact on HIV-1 progression
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