Study shows high burden of STIs among women living with HIV and need for integrated HIV and STI care

3 October 2022

A CAPRISA-led study entitled ‘Burden of sexually transmitted infections from acute HIV infection among women in South Africa: Evidence from a prospective cohort study’ showed a high prevalence and incidence of four curable sexually transmitted infections (STIs) Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, and Mycoplasma genitalium in this cohort of women from acute to chronic HIV infection and on antiretroviral therapy (ART) in KwaZulu-Natal, South Africa.

Results from this CAPRISA 002 acute HIV infection study were published in the Annals of Epidemiology Journal. HIV and other STIs often co-occur, but less is known about the long-term STI dynamics among persons living with HIV in sub-Saharan Africa.

The CAPRISA 002 study enrolled women with acute HIV infection and performed STI testing and treatment bi-annually from 2004-2020. The study team estimated STI prevalence, incidence and re-infections before and after ART initiation, and fitted Cox regression models to identify factors associated with STIs. Researchers followed 235 women with a median age of 25 years for a median of 7.5 years. New STI and re-infection cases per 100 person-years were 5.1 and 9.5 for Neisseria gonorrhoeae, 7.4 and 14.7 for Chlamydia trachomatis, 8.0 and 26.6 for Trichomonas vaginalis, 7.7 and 16.7 for Mycoplasma genitalium and 25.2 and 37.3 for any of these STIs.

STI incidence, was associated with HIV viral load (aHR=1.24, 95%CI 1.06-1.44), active syphilis (aHR=16.55, 95%CI 7.49-36.55), a positive HSV-2 PCR (aHR=1.54, 95%CI 1.01-2.35), bacterial vaginosis (aHR=1.48, 95%CI 1.01-2.18), recent regular sexual partners at enrol-ment (2+ vs none: aHR=3.68, 95% CI 1.79-7.59) and age (5-year fold: aHR=0.80, 95% CI 0.70-0.92).

Mr Kwabena Asare, lead author and PhD student at CAPRISA/UKZN, supervised by Prof Nigel Garrett, Head of Vaccines and Pathogenesis concluded that the high STI/HIV co-infection burden among these women showed that early HIV diagnosis and ART initiation needs to be combined with better STI care for women and their partners to prevent HIV and STI complications and transmissions.

For more reading see:  Asare K, et al. Annals of Epidemiology 2022; 74:132-139