Increases in HIV Incidence Following Receptive Anal Intercourse Among Women: A Systematic Review and Meta-analysis

ObjectivesCo-infection of syphilis and HIV remains hard to manage and its morbidity shows a rising tendency. Syphilis has been associated with increased risk of HIV acquisition in high-risk groups, especially in men who have sex with men (MSM). This systematic review and meta-analysis estimates the effect of syphilis infection on subsequent HIV acquisition, and assesses its difference between MSM and other high-risk populations.MethodsFive electronic databases were searched for literature published to 21 September 2019 without language restrictions. Longitudinal studies that enrolled key populations to compare the incidence of HIV with and without syphilis exposure were included. We used a random-effects model to estimate the effect of syphilis infection on HIV acquisition among high-risk populations, which include MSM, sex workers, serodiscordant couples, people who inject drugs and attendees of STD clinics.ResultsA total of 17 cohorts and 5 case-control studies involving 65 232 participants were included. HIV incidence showed a two-time increase after syphilis exposure, compared with a control group (relative risk (RR) 2.67 (95% CI 2.05 to 3.47); p<0.05 for prevalence; RR 3.21 (95% CI 2.26 to 4.57); p=0.419 for incidence). No significant differences were observed between MSM and other high-risk groups in syphilis infection prevalence (RR 2.60 (95% CI 1.78 to 3.80); p<0.05 vs RR, 2.98 (95% CI 2.15 to 4.14); p<0.05; ratio of relative risk 0.76 (95% CI 0.49 to 1.17)).ConclusionsSyphilis infection increases the risk of HIV acquisition in high-risk populations. There is no evidence to suggest MSM are at greater risk than other high-risk populations. Prompt diagnosis, timely treatment, preventive interventions against syphilis infection would be a worthwhile investment for reducing HIV incidence. Strategies to combat stigma and discrimination targeted at MSM are pragmatically needed.

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Predictive factors for HIV infection among men who have sex with men and who are seeking PrEP: a secondary analysis of the PROUD trial

Sexually Transmitted Infections ◽

10.1136/sextrans-2018-053808 ◽

2019 ◽

Vol 95 (6) ◽

pp. 449-454 ◽

Cited By ~ 4

Author(s):

Ellen White ◽

David T Dunn ◽

Monica Desai ◽

Mitzy Gafos ◽

Peter Kirwan ◽

...

Keyword(s):

Hiv Infection ◽

Incidence Rate ◽

Secondary Analysis ◽

Anal Intercourse ◽

Receptive Anal Intercourse ◽

Hiv Incidence ◽

Open Label ◽

Eligibility Criteria ◽

Sex With Men ◽

Hiv Acquisition

ObjectivesPre-exposure prophylaxis (PrEP) is a highly effective method of HIV prevention for men who have sex with men (MSM). However, uncertainty remains around the optimal eligibility criteria for PrEP, specifically whether there are subgroups at low risk of HIV for whom PrEP might not be warranted.MethodsPROUD was an open-label waitlist trial design that randomised MSM attending participating sexual health centres in England to receive PrEP immediately (IMM) or after a deferral period of 1 year (DEF). This analysis is based on participants who were randomised to the deferred arm, when they did not have access to PrEP. HIV incidence was compared between subgroups defined by baseline characteristics.ResultsOverall, 21 participants acquired HIV infection over 239.3 person-years (PY) follow-up, yielding an incidence rate of 8.8/100 PY (95% CI 5.4 to 13.4). Two highly significant predictors for HIV acquisition were identified. Men with a self-reported diagnosis of syphilis, rectal chlamydia (CT) or rectal gonorrhoea (GC) in the previous 12 months had an incidence of 17.2/100 PY (95% CI 9.7 to 28.5); those reporting receptive anal intercourse without a condom (ncRAI) with two or more partners in the previous 3 months had an incidence of 13.6/100 PY (95% CI 7.9 to 21.7). The incidence rate among participants lacking both of these risk factors was 1.1/100 PY (1/87.6, 95% CI 0.03 to 6.4).ConclusionsThe high HIV incidence in PROUD suggests that most participants appropriately judged their need for PrEP. Eligibility criteria for a PrEP programme can therefore be broad, as in the current guidelines. However, a recent history of syphilis or rectal CT/GC, or multiple ncRAI partners indicates a high imminent risk of HIV infection. MSM with any of these characteristics should be offered PrEP as a matter of urgency.

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Recent levels and trends in HIV incidence rates among adolescent girls and young women in ten high-prevalence African countries: a systematic review and meta-analysis

The Lancet Global Health ◽

10.1016/s2214-109x(19)30410-3 ◽

2019 ◽

Vol 7 (11) ◽

pp. e1521-e1540 ◽

Cited By ~ 15

Author(s):

Isolde Birdthistle ◽

Clare Tanton ◽

Andrew Tomita ◽

Kristen de Graaf ◽

Susan B Schaffnit ◽

...

Keyword(s):

Systematic Review ◽

Adolescent Girls ◽

Young Women ◽

Meta Analysis ◽

Incidence Rates ◽

Hiv Incidence ◽

African Countries ◽

High Prevalence

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Prevalence and Frequency of Heterosexual Anal Intercourse Among Young People: A Systematic Review and Meta-analysis

AIDS and Behavior ◽

10.1007/s10461-015-0997-y ◽

2015 ◽

Vol 19 (7) ◽

pp. 1338-1360 ◽

Cited By ~ 27

Author(s):

Branwen N. Owen ◽

Patrick M. Brock ◽

Ailsa R. Butler ◽

Michael Pickles ◽

Marc Brisson ◽

...

Keyword(s):

Systematic Review ◽

Young People ◽

Meta Analysis ◽

Anal Intercourse ◽

Heterosexual Anal Intercourse

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HIV incidence among men who have sex with men in mainland China: a systematic review protocol

Systematic Reviews ◽

10.1186/s13643-021-01828-w ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Wenting Huang ◽

Liming Wang ◽

Mi Guodong ◽

Ryan J. Zahn ◽

Jennifer Taussig ◽

...

Keyword(s):

Systematic Review ◽

Assessment Tool ◽

Meta Analysis ◽

Temporal Trends ◽

Mainland China ◽

Hiv Infections ◽

Future Research ◽

Hiv Incidence ◽

Geographic Variations ◽

Sex With Men

Abstract Background Men who have sex with men (MSM) are disproportionately affected by HIV in China. Globally, younger MSM are at higher risk for incident HIV infections, but there has been substantial variation in the estimates of age-stratified HIV incidence among MSM in mainland China, potentially due to regional differences in the nature of the epidemic. Given the need for quality epidemiological data to meet the global goal of ending new HIV infections by 2030, this systematic review and meta-analysis aims to determine age-stratified HIV incidence in mainland China, including consideration by geographic region and time. Methods This review will include longitudinal studies, cross-sectional surveys, and surveillance reports among MSM in mainland China that have reported HIV incidence. We will search studies and reports published from January 1, 2003, to April 30, 2020, in both English and Chinese language literature databases. For each study considered, two reviewers will independently screen, determine eligibility, and extract relevant data, with discrepancies resolved by consensus of a third reviewer. The methodological quality of included studies will be assessed by the Quality Assessment Tool for Systematic Reviews of Observational Studies Score (QATSO). We will develop age-stratified estimates of HIV incidence with geographic variations and temporal trends. Heterogeneity will be examined using statistical techniques appropriate to the dataset. For subgroup analyses, we will conduct mixed-effects meta-analysis models. Discussion This review will contribute to a better understanding of the HIV epidemic among MSM in mainland China by providing age-stratified estimates of HIV incidence with a portrayal of geographic and temporal variations. Findings will reflect epidemic dynamics, informing local and national intervention programs and policies for HIV prevention, and providing estimation data to inform future research among MSM in China. Systematic review registration PROSPERO ID 154834

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Detection of Chlamydia trachomatis in rectal specimens in women and its association with anal intercourse: a systematic review and meta-analysis

Sexually Transmitted Infections ◽

10.1136/sextrans-2017-053161 ◽

2018 ◽

Vol 94 (5) ◽

pp. 320-326 ◽

Cited By ~ 25

Author(s):

Nastassya L Chandra ◽

Claire Broad ◽

Kate Folkard ◽

Katy Town ◽

Emma M Harding-Esch ◽

...

Keyword(s):

Systematic Review ◽

Chlamydia Trachomatis ◽

Case Reports ◽

Meta Analysis ◽

Anal Intercourse ◽

High Income ◽

Nucleic Acid Amplification ◽

Chlamydia Infection ◽

Policy And Practice ◽

Eligibility Criteria

ObjectivesChlamydia trachomatis is the most commonly diagnosed bacterial STI. Lack of prevalence and risk factor data for rectal chlamydia in women has testing and treatment implications, as azithromycin (a first-line urogenital chlamydia treatment) may be less effective for rectal chlamydia. We conducted a systematic review of studies on women in high-income countries to estimate rectal chlamydia prevalence, concurrency with urogenital chlamydia and associations with reported anal intercourse (AI).DesignSystematic review and four meta-analyses conducted using random-effects modelling.Data sourcesMedline, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and the Cochrane Database were searched for articles published between January 1997 and October 2017.Eligibility criteriaStudies reporting rectal chlamydia positivity in heterosexual women aged ≥15 years old in high-income countries were included. Studies must have used nucleic acid amplification tests and reported both the total number of women tested for rectal chlamydia and the number of rectal chlamydia infections detected. Conference abstracts, case reports and studies with self-reported diagnoses were excluded. Data extracted included setting, rectal and urogenital chlamydia testing results, AI history, and demographics.ResultsFourteen eligible studies were identified, all among diverse populations attending sexual health services. Among routine clinic-attending women, summary rectal chlamydia positivity was 6.0% (95% CI 3.2% to 8.9%); summary concurrent rectal chlamydia infection was 68.1% in those who tested positive for urogenital chlamydia (95% CI 56.6% to 79.6%); and of those who tested negative for urogenital chlamydia, 2.2% (95% CI 0% to 5.2%) were positive for rectal chlamydia. Reported AI was not associated with rectal chlamydia (summary risk ratio 0.90; 95% CI 0.75 to 1.10).ConclusionsHigh levels of rectal chlamydia infection have been shown in women with urogenital chlamydia infection. The absence of association between reported AI and rectal chlamydia suggests AI is not an adequate indicator for rectal testing. Further work is needed to determine policy and practice for routine rectal testing in women.

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Factors associated with anorectal Chlamydia trachomatis or Neisseria gonorrhoeae test positivity in women: a systematic review and meta-analysis

Sexually Transmitted Infections ◽

10.1136/sextrans-2018-053950 ◽

2019 ◽

Vol 95 (5) ◽

pp. 361-367 ◽

Cited By ~ 5

Author(s):

Andrew Lau ◽

Fabian Yuh Shiong Kong ◽

Willa Huston ◽

Eric P F Chow ◽

Christopher K Fairley ◽

...

Keyword(s):

Systematic Review ◽

Chlamydia Trachomatis ◽

Neisseria Gonorrhoeae ◽

English Language ◽

Meta Analysis ◽

Prevalence Ratio ◽

Anal Intercourse ◽

Summary Estimate ◽

Language Studies ◽

Meta Analyses

ObjectivesThere has been considerable discussion about anorectal Chlamydia trachomatis (CT) in women, with some calling for anorectal CT screening, but little about anorectal Neisseria gonorrhoeae (NG). Given that urogenital NG is more strongly associated with pelvic inflammatory disease, this is an evidence gap. This systematic review and meta-analysis investigates the associations between anorectal CT in women and CT positivity at other sites (urogenital/oropharyngeal) and with anal intercourse, and compares these with anorectal NG within the same study populations.MethodsElectronic databases were searched for English-language studies published to October 2018 using the following terms: (“Chlamydia” OR “Chlamydia trachomatis”) AND ((“anal” OR “rect*” OR “anorect*”) OR (“extra?genital” OR “multi?site”)). Studies were included if anorectal NG data were available. Random-effects meta-analyses calculated pooled estimates; heterogeneity was investigated using meta-regression.Results25 studies were eligible. Anorectal CT positivity ranged from 0% to 17.5%, with a summary estimate of 8.0% (95% CI 7.0 to 9.1; I2=88.5%). Anorectal NG positivity ranged from 0% to 17.0%, with a summary estimate of 2.1% (95% CI 1.6 to 2.8; I2=92.7%). The association between urogenital and anorectal positivity was stronger for NG than CT (summary prevalence ratio (PR)=89.3 (95% CI 53.1 to 150.3; I2=80.1%), PR=32.2 (95% CI 25.6 to 40.7; I2=70.3%), respectively), and between oropharyngeal and anorectal positivity it was stronger for NG than CT (PR=34.8 (95% CI 10.2 to 118.2; I2=89.9%), PR=8.8 (95% CI 6.8 to 11.5; I2=58.1%), respectively). Anal intercourse was associated with anorectal NG (PR=4.3; 95% CI 2.2 to 8.6; I2=0.0%) but not with anorectal CT (PR=1.0; 95% CI 0.7 to 1.4; I2=0.0%).ConclusionsAnorectal CT is more common than anorectal NG, but anorectal NG is more strongly associated with anal intercourse, urogenital and oropharyngeal NG, suggesting that ongoing discussion about anorectal CT should also include NG. Longitudinal data are required to further understanding of the aetiology of anorectal STIs and assess whether anorectal screening is needed in women.Trial registration numberCRD42df017080188.

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