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Risk of HIV Acquisition Among Men Who Have Sex With Men Infected With Bacterial Sexually Transmitted Infections: A

Mohsen Malekinejad, Erin K Barker1, Rikita Merai2

  • 1From the Philip R. Lee Institute for Health Policy Studies.

Sexually Transmitted Diseases
|March 30, 2021
PubMed
Abstract

Insights

Men who have sex with men (MSM) with bacterial sexually transmitted infections (STIs) face a doubled risk of HIV acquisition. Infections with syphilis, gonorrhea, or chlamydia significantly increase HIV risk in MSM.

Area of Science:

  • Public Health
  • Epidemiology
  • Infectious Diseases

Background:

  • Bacterial sexually transmitted infections (STIs) are known risk factors for HIV acquisition among men who have sex with men (MSM).
  • Previous risk estimates require updating and enhancement to reflect current data.

Purpose of the Study:

  • To systematically review and meta-analyze existing peer-reviewed studies.
  • To assess the quantitative risk of HIV infection associated with specific bacterial STIs in MSM.

Main Methods:

  • Systematic review of 3 databases through December 2017.
  • Inclusion of peer-reviewed studies assessing HIV risk attributable to Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), Neisseria gonorrhoeae (NG), Treponema pallidum (TP), and Trichomonas vaginalis (TV).
  • Meta-analysis of risk ratios (RRs) and assessment of risk of bias, excluding studies with self-reported data or simultaneous STI/HIV assessment.

Main Results:

  • 26 studies yielded 39 risk ratios (RRs) for HIV acquisition linked to TP, NG, or CT.
  • HIV acquisition risk was significantly increased for TP (RR, 2.68), NG (RR, 2.38), and CT (k=7; RR, 1.99).
  • Pooled RRs were higher for studies with lower risk of bias, particularly for NG (RR, 5.49) and TP (RR, 4.32), despite moderate to high heterogeneity.

Conclusions:

  • Men who have sex with men (MSM) infected with Treponema pallidum (TP), Neisseria gonorrhoeae (NG), or Chlamydia trachomatis (CT) have at least double the risk of HIV acquisition.
  • Data heterogeneity and risk of bias introduce uncertainties into the precise risk estimates.
  • Further research may be needed to clarify these associations and inform prevention strategies.

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