title: The effect of genital tract infections on HIV-1 shedding in the genital tract: a systematic review and meta-analysis.
abstract: This article reviews the effect of genital tract infections and associated clinical conditions on the detection and concentration of HIV-1 shedding in the genital tract. A search of the PubMed, Embase, and AIDSearch databases was conducted. Meta-analysis was performed on those studies that reported the effect of genital tract infections on the detection of HIV-1 shedding. Thirty-nine studies met the inclusion criteria. The odds of HIV-1 detection in the genital tract were increased most substantially by urethritis (OR 3.1, 95% CI: 1.1-8.6) and cervicitis (OR 2.7, 95% CI: 1.4-5.2). The odds of HIV-1 detection were also increased significantly in the presence of cervical discharge or mucopus (OR 1.8, 95% CI: 1.2-2.7), gonorrhoea (OR 1.8, 95% CI: 1.2-2.7), chlamydial infection (OR 1.8, 95% CI: 1.1-3.1), and vulvovaginal candidiasis (OR 1.8, 95% CI: 1.3-2.4). Other infections and clinical conditions were found to have no significant effect on the detection of HIV-1, although HSV-2 shedding was found to increase the concentration of HIV-1 shedding, and genital ulcer disease was found to increase the odds of HIV-1 detection significantly after excluding one biased study (OR 2.4, 95% CI: 1.2-4.9). This analysis shows that infections that are associated with significant increases in leukocyte concentrations in the genital tract are also associated with significant increases in HIV-1 shedding. These infections are likely to be particularly important in promoting the sexual transmission and mother-to-child intrapartum transmission of HIV-1, and should therefore be the focus of HIV prevention strategies.
authors.affiliation: Centre for Actuarial Research, University of Cape Town, South Africa. leigh.johnson@uct.ac.za
authors.forename: Leigh F
authors.initials: LF
authors.lastname: Johnson
authors.forename: David A
authors.initials: DA
authors.lastname: Lewis
mesh_terms: D002181:Candidiasis, Vulvovaginal / Q000150:complications / Q000382:microbiology; D002690:Chlamydia Infections / Q000150:complications / Q000382:microbiology; D005260:Female; D005831:Genital Diseases, Female / Q000150:complications* / Q000382:microbiology; D005832:Genital Diseases, Male / Q000150:complications* / Q000382:microbiology; D005836:Genitalia, Female / Q000382:microbiology / Q000821:virology*; D005837:Genitalia, Male / Q000382:microbiology / Q000821:virology*; D006069:Gonorrhea / Q000150:complications / Q000382:microbiology; D015658:HIV Infections / Q000150:complications / Q000821:virology; D015497:HIV-1 / Q000502:physiology*; D006801:Humans; D008297:Male; D017201:Virus Shedding