Sexually transmitted infections and HIV RNA levels in blood and anogenital compartments among Thai men who have sex with men before and after antiretroviral therapy: implication for Treatment as Prevention programme

Abstract

IntroductionSexually transmitted infections (STIs) are common among HIV‐positive men who have sex with men (MSM). There have been concerns that undiagnosed and untreated STIs could undermine efforts to use antiretroviral therapy (ART) for prevention due to genital secretion infectiousness. We evaluated the correlation between STIs and HIV RNA in anogenital compartments among HIV‐positive MSM before and after ART.MethodsMSM participants newly diagnosed with HIV were offered ART regardless of CD4 count during November 2012 to November 2015. Syphilis serology, oropharyngeal swab, rectal swab, urine collection for gonorrhoea and chlamydia nucleic acid amplification testing, and HIV RNA measurement in blood, semen and rectal samples were performed at baseline, 12 and 24 months thereafter.ResultsOf 143 HIV‐positive MSM, 16.1% had syphilis, 23.1% had gonorrhoea and 32.8% had chlamydia at baseline. Participants with STIs at baseline had higher median HIV RNA levels in blood plasma (p = 0.053), seminal plasma (p = 0.01) and rectal secretions (p = 0.002) than those without STIs. Multivariate models identified HIV RNA 100,000 to 500,000 (OR 6.74, 95% CI 2.24 to 20.28, p = 0.001) and >500,000 (OR 9.39, 95% CI 1.08 to 81.72, p = 0.04) copies/mL in blood, CD4 count <350 cells/mm3 (OR 4.20, 95% CI 1.05 to 16.70, p = 0.04) and having any STIs (OR 2.62, 95% CI 1.01 to 6.80 p = 0.047) to be associated with detectable (>40 copies/mL) seminal plasma HIV RNA. Having chlamydia at any sites (OR 3.17, 95% CI 1.07 to 9.44, p = 0.04) was associated with detectable rectal HIV RNA. Incidences of syphilis, gonorrhoea and chlamydia were 13.4, 16.4 and 18.1 per 100 person‐years respectively. Nine participants had detectable HIV RNA (five in blood, one in semen, two in rectal samples and one in both blood and rectal samples) at 12 and/or 24 months after ART.ConclusionsSTIs were extremely common among HIV‐positive MSM prior to and after ART. ART effectively reduced HIV RNA in all compartments. The correlation between STIs and anogenital HIV RNA, especially prior to ART and likely until complete HIV RNA suppression from ART is achieved, points to the importance of integrating asymptomatic STIs screening into Treatment as Prevention programme for MSM.

Incidence of syphilis among HIV-infected men in Singapore, 2006–2017: temporal trends and associated risk factors

“…In our study, about three-quarters of HIV-infected men with incident syphilis had undetectable viral load at the time they were tested positive for syphilis, and there was no significant difference in the proportion between MSM and heterosexual men (figure 2). While a study found no evidence of STIs altering the paradigm of ‘Undetectable=Untransmittable’ (‘U=U’) among HIV-positive MSM on ART in Thailand, those with STIs had higher levels of anogenital HIV RNA at the time of diagnosis, especially prior to commencement of ART 29. This underscores the importance of integrating asymptomatic STI screening as part of universal treatment as prevention strategies.…”

Leveraging early HIV diagnosis and treatment in Thailand to conduct HIV cure research

“…The test-and-treat approach combines periodic HIV testing and immediate ART initiation. At-risk populations screened within this intervention strategy are motivated to initiate ART as soon as possible, thereby achieving a life expectancy similar to HIV-uninfected people [22, 36, 37]. In 2012, 810 Thai MSM and TGW were enrolled in a test-and-treat study in Bangkok, Ubon Ratchathani, Lampang and Mahasarakam that newly-diagnosed 134 (16.5%) PLWH [38].…”

Sexually transmitted infections among HIV serodiscordant partners: A secondary analysis of HIV Prevention Trial Network 052

“…Among gay men on ART in Thailand, ART effectively suppressed HIV RNA at months 12 and 24 after initiating ART although the rates of STIs remained high during the study. 20 STIs do not increase infectiousness of HIV-positive index cases, as demonstrated in HPTN 052 and more recently in studies of MSM. 21,22 Given the potency and effectiveness of ART in reducing viral load and preventing HIV transmission, any relative contribution of STIs to HIV acquisition appears difficult to quantify for those on ART.…”