Recurrent or persistent co-infections may increase HIV viral load (VL) and, consequently, risk of HIV transmission, thus increasing HIV incidence. We evaluated the association between malaria, HSV-2 and TB co-infections and their treatment on HIV VL.
Systematic review and meta-analysis of the association of malaria, HSV-2 and tuberculosis co-infections and their treatment on HIV VL.
PunMed and Embase databases were searched to February 10 2010 for studies in adults that reported HIV plasma and/or genital VL by co-infection status or treatment. Meta-analyses were conducted using random-effects models.
Forty-five eligible articles were identified (6 malaria, 20 HSV-2 and 19 tuberculosis). There was strong evidence of increased HIV VL with acute malaria (0.67 log10 copies/mL, 95% CI: 0.15, 1.19) and decreased VL following treatment (-0.37 log10 copies/mL, 95% CI: -0.70, -0.04). Similarly, HSV-2 infection was associated with increased HIV VL (0.18 log10 copies/mL, 95% CI: 0.01, 0.34), which decreased with HSV suppressive therapy (-0.28 log10 copies/mL, 95% CI: -0.36, -0.19). Active tuberculosis was associated with increased HIV VL (log10 copies/mL 0.40, 95% CI: 0.13-0.67), but there was no association between tuberculosis treatment and VL reduction (log10 copies/mL -0.02, 95% CI -0.19, 0.15).
Co-infections may increase HIV VL in populations where they are prevalent, thereby facilitating HIV transmission. These effects may be reversed with treatment. However, to limit HIV trajectory and optimize positive prevention for HIV-infected individuals pre-ART, we must better understand the mechanisms responsible for augmented VL and the magnitude of VL reduction required, and retune treatment regimens accordingly.