Modelling the impact of chlamydia screening on the transmission of HIV among men who have sex with men

BMC Infectious Diseases

Marianne AB van der Sande⁶  Maarten F Schim van der Loeff⁵  Maaike G van Veen⁷  Maarten J Postma⁸  Henry JC de Vries³  Maria Prins⁵  Bart JA Rijnders⁴  Suzanne E Geerlings²  Jan M Prins²  Johannes S Fennema⁷  Jacco Wallinga¹  Anna K Lugner¹  Henrike J Vriend²  Maria Xiridou¹ 

[1]National Institute of Public Health and Environment, P.O. Box 1, 3720, BA Bilthoven, the Netherlands

[2]Department of Internal Medicine, Academic Medical Centre, Amsterdam, the Netherlands

[3]Department of Dermatology, Academic Medical Centre, Amsterdam, the Netherlands

[4]Department of Internal Medicine and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, the Netherlands

[5]Research Department, Public Health Service of Amsterdam, Amsterdam, the Netherlands

[6]Julius Center, University Medical Centre, Utrecht, the Netherlands

[7]STI Outpatient Clinic, Public Health Service of Amsterdam, Amsterdam, the Netherlands

[8]Department of Pharmacy, University of Groningen, Groningen, the Netherlands

关键词: Chlamydia screening;    Mathematical model;    Men who have sex with men;    Chlamydia trachomatis;    HIV;   

Others  :  1145737
DOI  :  10.1186/1471-2334-13-436

 received in 2013-02-25, accepted in 2013-09-16,  发布年份 2013

【 摘 要 】

Background

Recent studies have found high prevalences of asymptomatic rectal chlamydia among HIV-infected men who have sex with men (MSM). Chlamydia could increase the infectivity of HIV and the susceptibility to HIV infection. We investigate the role of chlamydia in the spread of HIV among MSM and the possible impact of routine chlamydia screening among HIV-infected MSM at HIV treatment centres on the incidence of chlamydia and HIV in the overall MSM population.

Methods

A mathematical model was developed to describe the transmission of HIV and chlamydia among MSM. Parameters relating to sexual behaviour were estimated from data from the Amsterdam Cohort Study among MSM. Uncertainty analysis was carried out for model parameters without confident estimates. The effects of different screening strategies for chlamydia were investigated.

Results

Among all new HIV infections in MSM, 15% can be attributed to chlamydia infection. Introduction of routine chlamydia screening every six months among HIV-infected MSM during regular HIV consultations can reduce the incidence of both infections among MSM: after 10 years, the relative percentage reduction in chlamydia incidence would be 15% and in HIV incidence 4%, compared to the current situation. Chlamydia screening is more effective in reducing HIV incidence with more frequent screening and with higher participation of the most risky MSM in the screening program.

Conclusions

Chlamydia infection could contribute to the transmission of HIV among MSM. Preventive measures reducing chlamydia prevalence, such as routine chlamydia screening of HIV-infected MSM, can result in a decline in the incidence of chlamydia and HIV.

【 授权许可】

   
2013 Xiridou et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

Figure 5.

【 参考文献 】

• [1]Heiligenberg M, Rijnders B, Schim van der Loeff M, de Vries H, van der Meijden W, Geerlings S, Fennema H, Prins M, Prins J: High prevalence of sexually transmitted infections in HIV-infected men during routing outpatient visits in the Netherlands. Sex Transm Dis 2012, 39:8-15.
• [2]Kent C, Chaw J, Wong W, Liska S, Gibson S, Hubbard G, Klausner J: Prevalence of rectal, urethral, and pharyngeal chlamydia and gonorrhea detected in two clinical settings among men who have sex with men: San Francisco, California, 2003. Clin Infect Dis 2005, 41:67-74.
• [3]Hamlyn E, Welz T, Rebaudengo S, Simms H, Poulton M: Sexual behaviour, condom use and rates of sexually transmitted infections in HIV clinic attendees in South East London. Int J STD AIDS 2009, 20:757-760.
• [4]Dang T, Jaton-Ogay K, Flepp M, Kovari H, Evison J, Fehr J, Schmid P, Boffi El Amari E, Cavassini M, Odorico M, Tarr P, Greub G: High prevalence of anorectal chlamydial infection in HIV-infected men who have sex with men in Switzerland. Clin Infect Dis 2009, 49:1532-1535.
• [5]Chesson H, Pinkerton S: Sexually transmitted diseases and the increased risk for HIV transmission: implications for cost-effectiveness analyses of sexually transmitted disease prevention interventions. J Acquir Immune Defic Syndr 2000, 24:48-56.
• [6]Farley T, Cohen D, Wu S-Y, Besch C: The value of screening for sexually transmitted diseases in an HIV clinic. J Acquir Immune Defic Syndr 2003, 33:642-648.
• [7]Wasserheit J: Epidemiological synergy. Interrelationships between human immunodeficiency virus infection and other sexually transmitted diseases. Sex Transm Dis 1992, 19:61-77.
• [8]Coombs R, Reichelderfer P, Landay A: Recent observations on HIV type-1 infection in the genital tract of men and women. AIDS 2003, 17:455-480.
• [9]Sadiq S, Taylor S, Kaye S, Bennett J, Johnstone R, Byrne P, Copas A, Drake S, Pillay D, Weller I: The effects of antiretroviral therapy on HIV-1 RNA loads in seminal plasma in HIV-positive patients with and without urethritis. AIDS 2002, 16:219-225.
• [10]Bernstein K, Marcus J, Nieri G, Philip S, Klausner J: Rectal gonorrhea and chlamydia reinfection is associated with increased risk of HIV seroconversion. J Acquir Immune Defic Syndr 2010, 53:537-543.
• [11]Rottingen J, Cameron D, Garnett G: A systematic review of the epidemiologic interactions between sexually transmitted diseases and HIV: how much really is known? Sex Transm Dis 2001, 28:579-597.
• [12]Gras L, van Sighem A, Smit C, Zaheri S, Prins M, de Wolf F: Monitoring of Human Immunodeficiency Virus (HIV) infection in the Netherlands Report 2010. Amsterdam, The Netherlands: HIV Monitoring Foundation; 2010.
• [13]McKay M, Beckman R, Conover W: A comparison of three methods for selecting values of input variables in the analysis of output from a computer code. Technometrics 1979, 21:239-245.
• [14]van Sighem A, Smit C, Gras L, Holman R, Stolte I, Prins M, de Wolf F: Monitoring of Human Immunodeficiency Virus (HIV) infection in the Netherlands Report 2011. Amsterdam, The Netherlands: HIV Monitoring Foundation; 2011.
• [15]Stolte I: Sexual behaviour. In Final report of the health monitor of Amsterdam, 2008. Edited by Dijkshoorm H, van Dijk T, Janssen A. Amsterdam: GGD Amsterdam; 2009:121-125.
• [16]van Valkengoed I, Morre S, van den Brule A, Meijer C, Bouter L, van Eijk J, Boeke A: Follow-up, treatment, and reinfection rates among asymptomatic Chlamdyia trachomatis cases in general practice. Brit J Gener Pract 2002, 52:623-627.
• [17]Drummond F, Ryder N, Wand H, Guy R, Read P, McNulty A, Wray L, Donovan B: Is azithromycin adequate treatment for asymptomatic rectal chlamydia? Int J STD AIDS 2011, 22:478-480.
• [18]Juusola J, Brandeau M, Long E, Owens D, Bendavid E: The cost-effectiveness of symptom-based testing and routine screening of acute HIV infection in men who have sex with men in the USA. AIDS 2011, 25:1779-1787.
• [19]Boily M-C, Bastos F, Desai K, Mâsse B: Changes in the transmission dynamics of the HIV epidemic after the wide-scale use of antiretroviral therapy could explain increases in sexually transmitted infections. Sex Transm Dis 2004, 31:100-113.
• [20]Xiridou M, Geskus R, de Wit J, Coutinho R, Kretzschmar M: The contribution of steady and casual partnerships to the incidence of HIV infection among homosexual men in Amsterdam. AIDS 2003, 17:1029-1038.
• [21]Kelley C, Haaland R, Patel P, Evans-Strickfaden T, Farshy C, Hanson D, Mayer K, Lennox J, Brooks J, Hart C: HIV-1 RNA rectal shedding is reduced in men with low plasma HIV-1 RNA viral loads and is not enhanced by sexually transmitted bacterial infections in the rectum. J Inf Dis 2011, 204:761-767.
• [22]Johnson L, Dorrington R, Bradshaw D, Coetzee D: The role of sexually transmitted infections in the evolution of the South African HIV epidemic. Trop Med Int Health 2012, 17:161-168.
• [23]Van der Ploeg CPB, Van Vliet C, De Vlas SJ, Ndinya-Achola J, Fransen L, van Oortmarssen G, Habbema J: STDSlM: a microsimulation model for decision support on STD control. Interfaces 1998, 28:84-100.
• [24]Korenromp EL, Van Vliet C, Grosskurth H, Gavyole A, van der Ploeg C, Fransen L, Hayes R, Habbema J: Model-based evaluation of single-round mass treatment of sexually transmitted diseases for HIV control in a rural African population. AIDS 2000, 14:573-593.
• [25]Freeman EE, Orroth KK, White RG, Glynn J, Bakker R, Boily M, Habbema D, Buve A, Hayes R: Proportion of new HIV infections attributable to herpes simplex 2 increases over time: simulations of the changing role of sexually transmitted infections in sub-Saharan African HIV epidemics. Sex Transm Infect 2007, 83(Suppl 1):i17-i24.
• [26]Foss AM, Vickerman PT, Mayaud P, Weiss H, Ramesh B, Reza-Paul S, Washington R, Blanchard J, Moses S, Lowndes C, Alary M, Watts C: Modelling the interactions between herpes simplex virus type 2 and HIV: implications for the HIV epidemic in southern India. Sex Transm Infect 2011, 87:22-27.
• [27]Pilcher C, Price M, Hoffman I, Galvin S, Martinson F, Kazembe P, Eron J, Miller W, Fiscus S, Cohen M: Frequent detection of acute primary HIV infection in men in Malawi. AIDS 2004, 18:517-524.
• [28]Galvin SR, Cohen MS: The role of sexually transmitted diseases in HIV transmission. Nat Rev 2004, 2:33-42.
• [29]Op de Coul ELM, Warning TD, Koedijk FDH, on behalf of the Dutch STI clinics: Sexual behaviour and sexually transmitted infections in STI clinic attendees in the Netherlands, 2007–2011. Intern J STD AIDS 2013. In press
• [30]Wilson D, Hoare A, Regan D, Law M: Importance of promoting HIV testing for preventing secondary tranmissions: modelling the Australian HIV epidemic among men who have sex with men. Sex Health 2009, 6:19-33.
• [31]Xiridou M, Geskus R, de Wit J, Coutinho R, Kretzschmar M: Primary HIV infection as source of HIV transmission within steady and casual partnerships among homosexual men. AIDS 2004, 18:1311-1320.
• [32]Garnett GP, Hughes JP, Anderson RM, Stoner BP, Aral SO, Whittington WL, Handsfield JJ, Holmes KK: Sexual mixing patters of patients attending sexually transmitted diseases clinics. Sex Transm Dis 1996, 23:248-257.
• [33]Renton A, Whitaker L, Ison C, Wadsworth J, Harris JRW: Estimating the sexual mixing patterns in the general population from those in people acquiring gonorrhoea infection: theoretical foundation and empirical findings. J Epidem Commun Health 1995, 49:205-213.
• [34]Koopman J, Simon C, Jacquez J, Joseph J, Sattenspiel L, Park T: Sexual partner selectivenss effects on homosexual HIV transmission dynamics. JAIDS 1988, 1:486-504.
• [35]Garnett GP, Anderson RM: Sexually transmitted diseases and sexual behavior: insights from mathematical models. J Infect Dis 1996, 174(Suppl 2):S150-S161.
• [36]Busenberg S, Castillo-Chavez C: A general solution of the problem of mixing of subpopulations and its application to risk- and age-structured epidemic models for the spread of AIDS. IMA J Math Med Biol 1991, 8:1-29.
• [37]Ghani AC, Swinton J, Garnett GP: The role of sexual partnership networks in the epidemiology of gonorrhea. Sex Transm Dis 1997, 24:45-56.