Looking at the positives: proactive management of STIs in people with HIV

AIDS Research and Therapy

Carole Khaw¹  Daniel Richardson²  Tim Read³  Gail Matthews⁴ 

[1] Adelaide Sexual Health Centre (Clinic 275), Infectious Diseases Unit, Royal Adelaide Hospital;Department of Sexual Health and HIV Medicine, Brighton and Sussex Medical School;Melbourne Sexual Health Centre, Alfred Health;The Kirby Institute, University of New South Wales;

关键词: HIV;    Co-infection;    HCV;    Hepatitis C;    Syphilis;    Antimicrobial resistance;   

DOI  :  10.1186/s12981-018-0216-9

来源: DOAJ

【 摘 要 】

Abstract Patients who are HIV-positive and co-infected with other sexually transmitted infections (STIs) are at risk of increased morbidity and mortality. This is of clinical significance. There has been a dramatic increase in the incidence of STIs, particularly syphilis, gonorrhoea, Mycoplasma genitalium and hepatitis C virus (HCV) in HIV-positive patients. The reasons for this are multifactorial, but contributing factors may include effective treatment for HIV, increased STI testing, use of HIV pre-exposure prophylaxis and use of social media to meet sexual partners. The rate of syphilis–HIV co-infection is increasing, with a corresponding increase in its incidence in the wider community. HIV-positive patients infected with syphilis are more likely to have neurological invasion, causing syndromes of neurosyphilis and ocular syphilis. HIV infection accelerates HCV disease progression in co-infected patients, and liver disease is a leading cause of non-AIDS-related mortality among patients who are HIV-positive. Since several direct-acting antivirals have become subsidised in Australia, there has been an increase in treatment uptake and a decrease in HCV viraemia in HIV-positive patients. The incidence of other sexually transmitted bacterial infections such as Neisseria gonorrhoeae and M. genitalium is increasing in HIV patients, causing urethritis, proctitis and other syndromes. Increasing antimicrobial resistance has also become a major concern, making treatment of these infections challenging. Increased appropriate testing and vigilant management of these STIs with data acquisition on antimicrobial sensitivities and antimicrobial stewardship are essential to prevent ongoing epidemics and emergence of resistance. Although efforts to prevent, treat and reduce epidemics of STIs in patients living with HIV are underway, further advances are needed to reduce the significant morbidity associated with co-infection in this patient setting.

【 授权许可】

Unknown