The effect of sexually transmitted co-infections on HIV viral load amongst individuals on antiretroviral therapy : a systematic review and meta-analysis
Date
2015-06
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
Abstract
Background: Antiretroviral therapy (ART) markedly reduces HIV transmission, and testing and treatment programs
have been advocated as a method for decreasing transmission at the population level. Little is known, however,
about the extent to which sexually transmitted infections (STIs), which increase the HIV infectiousness of untreated
individuals, may decrease the effectiveness of treatment as prevention.
Methods: We searched major bibliographic databases to August 12th, 2014 and identified studies reporting differences
in HIV transmission rate or in viral load between individuals on ART who either were or were not co-infected with
another STI. We used hierarchical Bayesian models to estimate viral load differences between individuals with and
without STI co-infections.
Results: The search strategy retrieved 1630 unique citations of which 14 studies (reporting on 4607 HIV viral load
measurements from 2835 unique individuals) met the inclusion criteria. We did not find any suitable studies that
estimated transmission rates directly in both groups. Our meta-analysis of HIV viral load measurements among
treated individuals did not find a statistically significant effect of STI co-infection; viral loads were, on average,
0.11 log10 (95 % CI −0.62 to 0.83) higher among co-infected versus non-co-infected individuals.
Conclusions: Direct evidence about the effects of STI co-infection on transmission from individuals on ART is very
limited. Available data suggests that the average effect of STI co-infection on HIV viral load in individuals on ART
is less than 1 log10 difference, and thus unlikely to decrease the effectiveness of treatment as prevention. However,
there is not enough data to rule out the possibility that particular STIs pose a larger threat.
Description
CITATION: Champredon, D. et al. 2015. The effect of sexually transmitted co-infections on HIV viral load amongst individuals on antiretroviral therapy : a systematic review and meta-analysis. BMC Infectious Diseases, 15:249, doi:10.1186/s12879-015-0961-5.
The original publication is available at http://bmcinfectdis.biomedcentral.com
The original publication is available at http://bmcinfectdis.biomedcentral.com
Keywords
Sexually transmitted diseases, HIV infections -- Treatment, Antiretroviral therapy, Antiretroviral agents
Citation
Champredon, D. et al. 2015. The effect of sexually transmitted co-infections on HIV viral load amongst individuals on antiretroviral therapy : a systematic review and meta-analysis. BMC Infectious Diseases, 15:249, doi:10.1186/s12879-015-0961-5.