Risk of HIV Acquisition Among Men Who Have Sex With Men Infected With Bacterial Sexually Transmitted Infections: A Systematic Review and Meta-Analysis

Abstract

Background: Men who have sex with men (MSM) who have bacterial sexually transmitted infections (STIs) are at increased risk for HIV infection. We enhanced and updated past summary risk estimates.

Methods: We systematically reviewed (PROSPERO No. CRD42018084299) peer-reviewed studies assessing the risk of HIV infection among MSM attributable to Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), Neisseria gonorrhoeae (NG), Treponema pallidum (TP), and/or Trichomonas vaginalis (TV). We searched 3 databases through December 2017. We excluded studies with self-reported data or simultaneous STI and HIV assessment. We conducted dual screening and data extraction, meta-analytically pooled risk ratios (RRs), and assessed potential risk of bias.

Results: We included 26 studies yielding 39 RR (k) for HIV acquisition due to one of TP, NG, or CT. We did not identify eligible data for MG or TV, or for HIV transmission. HIV acquisition risk increased among MSM infected with TP (k = 21; RR, 2.68, 95% confidence interval [CI], 2.00-3.58), NG (k = 11; RR, 2.38; 95% CI, 1.56-3.61), and CT (k = 7; RR, 1.99; 95% CI, 1.59-2.48). Subanalysis RRs for all 3 pathogens were ≥1.66 and remained statistically significant across geography and methodological characteristics. Pooled RR increased for data with the lowest risk of bias for NG (k = 3; RR, 5.49; 95% CI, 1.11-27.05) and TP (k = 4; RR, 4.32; 95% CI, 2.20-8.51). We observed mostly moderate to high heterogeneity and moderate to high risk of bias.

Conclusions: Men who have sex with men infected with TP, NG, or CT have twice or greater risk of HIV acquisition, although uncertainties exist because of data heterogeneity and risk of bias.

Figure 1.

Identification and screening of bibliographic records for systematic review of the effect of STI diagnosis on the risk of HIV seroconversion among MSM (search up to January 2018)

Figure 2.

Assessment of risk of bias for effect sizes included in the meta-analysis of the effect of STI diagnosis on the risk of HIV acquisition among MSM.

Figure 3.. Forest plot for risk ratios of diagnosis of syphilis and risk of HIV acquisition

Heterogeneity chi-squared = 59.32 (d.f. = 20) Estimate of between-study variance Tau-squared = 0.2413 Test of ES=1, z= 6.71 p = 0.000 Studies included in Model 1: Giuliani 2014, Lam 2017, Thienkrua 2016b, Xu 2010 Studies included in Model 2: Desai 2017, Giuliani 2014, Lam 2017, Thienkrua 2016b, Xu 2010 Data from Kelly 2015 was removed since it had no effect on the pooled estimate (i.e., % weight = 0) but it would have distorted the figure.

Figure 4.. Forest plot for risk ratios of diagnosis of gonorrhea and risk of HIV acquisition among MSM

Heterogeneity chi-squared = 59.30 (d.f. = 9) Estimate of between-study variance Tau-squared = 0.3743 Test of ES=1: z= 3.69 p = 0.000 If Meireles 2015a (RR=0.002, CI= 0.001, 0.003) is included then the combined estimated RR would be 1.359 (0.420, 4.391). Studies included in Model 1: Giuliani 2014, Sanders 2013 Studies included in Model 2: Desai 2017, Giuliani 2014, Harrison 1999, Sanders 2013

Figure 5.. Forest plot for risk ratios of diagnosis of chlamydia and risk of HIV acquisition among MSM

Heterogeneity chi-squared = 8.49 (d.f. = 5) Estimate of between-study variance Tau-squared = 0.0348 Test of ES=1 : z= 5.66 p = 0.00 Studies included in Model 1: N/A Studies included in Model 2: N/A