title: The Role of Sexually Transmitted Infections in HIV-1 Progression: A Comprehensive Review of the Literature.
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.
authors: Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA ; Naval Health Research Center, San Diego, CA, USA.
authors: Helen M
authors: HM
authors: Chun
authors: Division of Infectious Diseases, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Suite 5, San Diego, CA 92134-1005, USA.
authors: Robert J
authors: RJ
authors: Carpenter
authors: Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
authors: Grace E
authors: GE
authors: Macalino
authors: Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA ; Naval Health Research Center, San Diego, CA, USA ; Division of Infectious Diseases, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Suite 5, San Diego, CA 92134-1005, USA ; San Diego State University, San Diego, CA, USA.
authors: Nancy F
authors: NF
authors: Crum-Cianflone