Sexually transmitted diseases enhance HIV transmission: no longer a hypothesis
Sexually transmitted diseases enhance HIV transmission: no longer a hypothesis
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DOI：
10.1016/s0140-6736(98)90002-2
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发表时间：
1998-06-01
期刊：
影响因子：
168.9
通讯作者：
Cohen, MS
中科院分区：
文献类型：
--
作者：
Cohen, MS
结论HIV-1传播与典型性传播疾病之间存在因果关系。22 '3'我们如何使用这些数据来计划HIV-1预防？已经开发了数学模型来预测不同干预措施对HIV-1传播的影响，36预防选择在很大程度上取决于所研究的辅助因素的流行程度和相对重要性。在性病和HIV-1同时发生的国家，性病的治疗有望以成本效益高的方式减少HIV-1的传播。36、37尽管现有数据难以集中于特定的STD，淋病对精液中HIV-1排泄的影响支持及时治疗这种感染。z 8男性和女性中滴虫病的高流行率也可能证明对HIV-1的传播很重要。此外，快速发展的数据似乎表明，阴道植物群的变化特征为细菌性阴道病可能有助于获得HIV-1。38，39为了减少发展中国家的HIV-1传播，必须优先重视性病的综合征管理和有效抗菌药物的使用。40.在无性病人群中，特别是妇女中，改进检测性病的方法也很重要。行为信息应继续鼓励寻求健康的行为和“安全性行为”，包括使用避孕套。4.“预期将制定以未感染艾滋病毒的个人为重点的行为信息，因为这一人群负责任的性行为对预防艾滋病毒-1是绝对必要的，在发达国家，性传播疾病对艾滋病毒-1传播的相对重要性更具争议性，主要是因为数据有限。在患有性病的患者中，HIV-1的流行率比一般人群高得多。[4]最近，美国和英国的研究发现，HIV-1患者的性病发病率持续上升（参考文献42、43和Myron S Cohen，未发表的数据）。必须在HIV-1阳性患者中进行经典性传播疾病的检测和治疗，以降低他们的病毒感染性，并在他们的伴侣中进行检测和治疗，以降低感染的易感性。
Conclusions A causal link between HIV-l transmission and classic STDs has been demonstrated. 22’3’How can we use these data to plan HIV-l prevention? Mathematical models have been developed to predict the impact of different interventions on HIV-l transmission, 36 and prevention choices depend heavily on the prevalence and relative importance of the cofactors examined. In countries where STDs and HIV-l coincide, treatment of STDs can be expected to reduce transmission of HIV-l in a costeffective manner. 36’37 Although available data make it difZficult to focus on particular STDs, the effects of gonorrhoea on excretion of HIV-l in semen support the timely treatment of this infection. z8 The high prevalence of trichomoniasis in both men and women may also prove to be important for HIV-l transmission. In addition, rapidly evolving data seem to show that the changes in vaginal flora characterised as bacterial vaginosis may facilitate acquisition of HIV-1. 38, 39 To reduce HIV-l transmission in developing countries, priority must be placed on syndromic management of STDs and use of effective antimicrobial drugs. 40 Improved ways to detect STDs in symptom-free people, especially women, are also essential. Behavioural messages should continue to encourage health-seeking behaviour and “safer sex” including condom use. 4” Development of behavioural messages focused on HIV-linfected individuals is anticipated, since responsible sexual behaviour in this population is absolutely essential for HIV-1 prevention.In developed countries, the relative importance of STDs for HIV-l transmission is more controversial, mainly because of limited data. The prevalence of HIV-l in patients that present with STDs is considerably higher than in the general population. 4’Recently, studies in the USA and UK have found continued incidence of STDs in patients with HIV-l disease (refs 42, 43, and Myron S Cohen, unpublished data). Detection and treatment of classic STDs must be undertaken in HIV-l-positive patients to reduce their viral infectiousness, and in their partners to reduce susceptibility to infection.