AEGiS-14IAC: The impact of syndromic treatment of sexually transmitted diseases on cervical shedding of HIV-1 in Ethiopia.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

The impact of syndromic treatment of sexually transmitted diseases on cervical shedding of HIV-1 in Ethiopia.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. TuOrD1153)

Wolday D, Mariam Z, Mohammed Z, Dorigo-Zetsma W, Girma M, Meles H, Seme W, Sanders E, Geyid A, Mayaan S
Ethio-Netherlands AIDS Research Project (ENARP), Ethiopian Health and Nutrition Research Institute (EHNRI), Addis Ababa, Ethiopia

BACKGROUND: Although syndromic treatment of sexually transmitted diseases (STDs) has been shown to reduce HIV incidence, .its impact in reducing HIV shedding in genital secretions is hardly known. Moreover, the impact among patients in whom STD treatment is not successful has not been previously studied. The objectives of this study were to examine the impact of syndromic treatment of STDs on the genital shedding of HIV-1 and the impact among patients in whom treatment was not successful.

METHODS: Seventy-one HIV-1-infected women were prospectively enrolled; 60 had symptomatic STDs [72% presenting with genital discharge syndrome (GDS) and 28% with genital ulcer syndrome (GUS)] and 11 controls did not have STDs. Cervical HIV RNA load in 65 (93%) women was measured, using NucliSens QT, at baseline and after WHO-based syndromic STD treatment algorithm.

RESULTS: HIV-infected women with STDs were more likely to have detectable cervical HIV-1 RNA compared with the controls (85% vs. 55%, P = 0.03), and their cervical HIV RNA load at entry was significantly higher (median 3.20 vs 1.90 log₁₀ RNA copies/ml, respectively, P = 0.02). In women with GUS, baseline cervical HIV RNA load was significantly higher than in those with GDS (3.46 vs. 2.96, respectively, P = 0.04). No significant reduction in cervical HIV RNA load was observed after syndromic treatment of STDs (3.20 vs. 2.61 respectively, P = 0.07). However, significant decreases in cervical HIV load were limited to only those with clinical improvement (2.96 vs. 2.23, espectively; P < 0.001). GUS (Odds ratio, 4.79; 95% confidence interval, 1.32-17.46) was significantly associated with unfavorable clinical outcome, independent of HIV load and CD4+ T-cell count.

CONCLUSIONS: The findings indicate that syndromic treatment of STDs impacts very little in reducing cervical HIV shedding underscoring the need for appropriate diagnosis and management of STDs in order to impact on control of heterosexual transmission of HIV.

Keywords: AEGIS, HIV-1, Sexually Transmitted Diseases, HIV Infections, HIV Seropositivity, CD4 Lymphocyte Count, Vaginal Discharge, Ethiopia, Human, Female, therapy

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