%0 Journal Article
%T The Role of Sexually Transmitted Infections in HIV-1 Progression: A Comprehensive Review of the Literature
%A Helen M. Chun
%A Robert J. Carpenter
%A Grace E. Macalino
%A Nancy F. Crum-Cianflone
%J Journal of Sexually Transmitted Diseases
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/176459
%X 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/¦ÌL 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. 1. Introduction Individuals infected with human immunodeficiency virus-1 (HIV-1) are often coinfected with other sexually transmitted infections (STIs) due to shared routes of transmission. Over the past decade, 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 HIV-1 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. 2. Herpes Simplex Virus Type-2 Most persons who are infected with HIV-1 are also infected with HSV-2, with published seropositivity rates of 50¨C90% [1, 2]. Globally, HSV-2 is the most common cause of
%U http://www.hindawi.com/journals/jstd/2013/176459/