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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.
Sexually Transmitted Diseases 2000;27(7):411-416.
Rothenberg RB, Wasserheit JN, St Louis ME, Douglas JM.
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.
