Identifying and managing infectious disease syndemics in patients with HIV

Abstract

Purpose of review: We will present recent articles focusing on HIV synergistic interactions with other sexually transmitted infections, tuberculosis, and hepatitis, as well as recent advances in the study of social and behavioral determinants that facilitate this clustering of infectious disease. For each synergistic interaction, we highlight evidence-based interventions that clinicians and policymakers should consider to tackle HIV and infectious disease syndemics.

Recent findings: Significant advances in understanding the behavioral and structural determinants of HIV and other infectious disease synergisms have been made in the past years. Intervention strategies based on these new models have also been developed. It is now well understood that treating infectious disease syndemics will require a multidisciplinary and multipronged approach.

Summary: HIV is synergistic with multiple other infectious diseases because the risk behaviors that lead to HIV acquisition may be similar to the other infections. The influence of HIV on the other infection may be due to immunosuppression associated with disease progression resulting in increased susceptibility (e.g., HIV and tuberculosis), especially when patients are not virologically suppressed using antiretroviral therapy. In reverse, another infectious disease may, when not treated, influence HIV disease progression. Social/structural determinants like homelessness, mass incarceration, and structural discrimination precipitate psychiatric comorbidity, substance use, and risky sex behavior which lead to the spread and co-occurrence of infectious disease.

Figure 1.

Diagram of infectious disease syndemic pathways for PWID (Original) This figure illustrates the ways in which different levels of synergies impact infectious disease syndemics for PWID. Arrows within the model indicate the direction of the synergistic effects. Larger arrows represent interactions that have been qualitatively deemed more significant for their respective populations.

Figure 2.

Diagram of infectious disease syndemic pathways for MSM (Original) This figure illustrates the ways in which different levels of synergies impact infectious disease syndemics for MSM. Arrows within the model indicate the direction of the synergistic effects. Larger arrows represent interactions that have been qualitatively deemed more significant for their respective populations.