Sexually transmitted infections as risk factors for HIV infection among MSMs: systematic review.

摘要

We published a 1999 review of studies exploring whether sexually transmitted infections (STIs) are causally associated with human immunodeficiency virus (HIV) infection among men who have sex with men (MSMs), finding few studies and no convincing evidence for associations. This contrasted with evidence then emerging of several STIs (especially ulcerative infections) being risk factors for HIV among the general population. We speculated that our findings might be explained by higher exposure to HIV among MSM and relatively higher transmission of HIV in anal than vaginal sex. A more recent review/meta-analysis by Freeman et al. focusing on herpes simplex virus (HSV)-2 reported a significant association of HSV-2 with HIV among MSMs [RR = 1.7; 95% confidence interval (CI) 1.2-2.4] but smaller than among the general population. This difference is plausible for the reasons above but does suggest STI control may nonetheless be important in MSM HIV prevention efforts. Another recent review/meta-analysis suggests other STIs, including syphilis, gonorrhoea, and chlamydia, may be risk factors for HIV among the general population but reports no findings for MSMs. We therefore decided to update our review to assess whether other STIs not merely HSV-2 might be important to address within HIV prevention for MSMs.