Rothenberg RB, Wasserheit JN, St Louis ME, Douglas JM. The effect of treating sexually transmitted diseases on the transmission of HIV in dually infected persons: a clinic-based estimate. Ad Hoc STD/HIV Transmission Group.
Sex Transm Dis 2000;
27:411-6. [PMID:
10949432 DOI:
10.1097/00007435-200008000-00006]
[Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND
The effect of sexually transmitted disease (STD) treatment on HIV transmission is a topic of considerable current interest and controversy.
GOAL
To assess the potential effect of STD treatment on HIV transmission in persons who are dually infected with STD and HIV.
STUDY DESIGN
Using data from eight STD clinic sites in the United States, the authors estimate the actual achievable reduction in HIV transmission by multiplying the prevented fraction associated with treatment of STDs (set at an average of 0.8) by the maximum potential reduction in HIV transmission achieved by treating STDs (using an average relative risk of 3.0 for increased HIV transmission in the presence of STDs). Subgroup analysis assessed infection proportions for genital ulcer disease, nonulcerative STDs, and any STD by sex, ethnicity, age, and sexual orientation.
RESULTS
The maximum achievable reduction in HIV transmission from dually infected persons to their partners is approximately 33%. The actual achievable reduction is approximately 27% (range, 10.0-38.1%) at the eight clinic sites. If each of the 4,516 dually infected persons in this cohort experienced a single sexual exposure with an uninfected person, 28 HIV infections would occur in the absence of STD treatment whereas 16 infections would occur with STD treatment.
CONCLUSIONS
The estimate of a 27% reduction provides a qualitative assessment of the potential impact of STD treatment on HIV transmission in the absence of any other behavioral intervention. Identification of dually infected persons in STD clinics is an important mechanism for targeting interventions to a social milieu with high risk for HIV infection and other STDs.
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