Untreated Genital Tract Inflammation Plays Role in HIV Transmission

Genital tract inflammation may play an important role in HIV transmission, and controlling sexually transmitted infections (STIs) and genital tract infections may help to reduce HIV incidence, according to a review article published in The Journal of Infectious Diseases.¹

Despite the significant efforts made to reduce the incidence of HIV, the management and treatment of curable STIs has been stagnant. Syndromic management remains the standard of care for STIs, despite the fact that most people with STIs are asymptomatic. In addition, sensitivity and specificity of syndromic management is limited for people who have genitourinary symptoms; therefore, most cases remain undiagnosed and untreated, and patients have ongoing inflammation that can increase transmission and acquisition of HIV.

The review highlights the results of a study that analyzed the role of genital abnormalities and hormonal contraception in HIV transmission among heterosexual serodifferent couples in Rwanda.²

Study results suggested that female partner genital ulceration and male partner nonulcerative STI were factors most linked to women’s HIV acquisition. Female partner nonulcerative STI, non-STI vaginal dysbiosis, and male partner genital ulceration were factors most linked to men’s HIV acquisition. In addition, the findings suggested that there was no association between hormonal contraception use and HIV transmission or acquisition.²

Authors of the review noted that the subcategorization of STI- and non-STI-associated inflammation and genital ulcerations are subject to misclassification, which can lead to false positives or false negatives. They also noted that these classifications may lead to a risk of over or under treatment in syndromic managed STIs, which in turn, can lead to an underestimated or overestimated effect.

With the evolution of diagnostics, treatments, and pathophysiology understandings, new opportunities are presenting for the screening and care of genital tract inflammation to reduce the risk of HIV transmission. The authors of the review noted that of more than 10 randomized controlled trials evaluating the link between STI treatment and HIV incidence reduction, there was a 40% decrease in HIV incidence; however, these results may be due to study limitations. 

“More research is needed to better understand how best to support individuals, especially in HIV-endemic regions, to engage sexual partners in STI notification and treatment,” the review authors noted.

“Given that [genital tract inflammation] is a risk factor for HIV and the known risk of post-treatment [genital tract inflammation] recurrence, emerging technology provides opportunities to ensure both patients and partners access HIV and [genital tract inflammation] screening and care, ultimately reducing HIV incidence, and promoting sexual and reproductive health,” they concluded.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

References

1. Chitneni P, Matthews LT. The other U=U. untested and untreated genital tract inflammation in people living with and exposed to HIV. J Infect Dis. Published online February 10, 2021. doi:10.1093/infdis/jiab074

2. Wall KM, Karita E, Nyombayire J, et al. Genital abnormalities, hormonal contraception, and HIV transmission risk in Rwanda serodifferent couples. J Infect Dis. Published online February 9, 2021. doi:10.1093/infdis/jiab071