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HIV and Sexually Transmitted Infections Understanding and addressing the HIV and STI syndemics Guest Editors: Kenneth H Mayer, Henry JC de Vries Supplement Editor: Marlène Bras Volume 22, Supplement 6, August 2019 Acknowledgements The Guest Editors - Kenneth H Mayer and Henry JC de Vries - would like to thank all of the authors who submitted expressions of interest and full manuscripts, and worked so hard throughout the rigorous selection process. We thank the STI 2018 Organizing Committee (https://www. iasociety.org/HIV-Programmes/Programmes/HIV-Co-Infections-and-Co-Morbidities/Events/STI-2018) for the ideas and overviews included in this supplement. We also thank Sébastien Morin, the editors and staff of the Journal of the International AIDS Society, as well as Mary Childs, for their professionalism and support throughout the process of organizing and producing this supplement. Support The publication of this supplement was made possible with support from the National Institutes of Health (NIH). Understanding and addressing the HIV and STI syndemics Guest Editors: Kenneth H Mayer, Henry JC de Vries Supplement Editor: Marlène Bras Contents HIV and sexually transmitted infections: reconciling estranged bedfellows in the U = U and PrEP era Kenneth H Mayer and Henry JC de Vries 1 Transforming and integrating STI surveillance to enhance global advocacy and investment in STI control Melanie M Taylor and Teodora EC Wi 4 Diagnosing sexually transmitted infections in resource-constrained settings: challenges and ways forward Teodora EC Wi, Francis J Ndowa, Cecilia Ferreyra, Cassandra Kelly-Cirino, Melanie M Taylor, Igor Toskin, James Kiarie, Nancy Santesso and Magnus Unemo 8 Similar, but different: drivers of the disproportionate HIV and sexually transmitted infection burden of key populations Kenneth H Mayer and Lao-Tzu Allan-Blitz 19 Sexually transmitted infections and HIV in the era of antiretroviral treatment and prevention: the biologic basis for epidemiologic synergy Myron S Cohen, Olivia D Council and Jane S Chen 23 Mechanisms of sexually transmitted infection-induced inflammation in women: implications for HIV risk Ruth Mwatelah, Lyle R McKinnon, Cheryl Baxter, Quarraisha Abdool Karim and Salim S Abdool Karim 32 The role of saliva in gonorrhoea and chlamydia transmission to extragenital sites among men who have sex with men: new insights into transmission Eric PF Chow and Christopher K Fairley 40 Current challenges in the clinical management of sexually transmitted infections Henry JC de Vries 46 Give PrEP a chance: moving on from the “risk compensation” concept Daniela Rojas Castro, Rosemary M Delabre and Jean-Michel Molina 50 Sexually transmitted hepatitis C virus infections: current trends, and recent advances in understanding the spread in men who have sex with men Bernadien M Nijmeijer, Jelle Koopsen, Janke Schinkel, Maria Prins and Teunis BH Geijtenbeek 57 Improving care for sexually transmitted infections Cornelis A Rietmeijer 67 Community engagement in the provision of culturally competent HIV and STI prevention services: lessons from the French experience in the era of PrEP Daniela Rojas Castro, Rosemary M Delabre, Stéphane Morel, David Michels and Bruno Spire 72 Author Index 75 Volume 22, Supplement 6 August 2019 Mayer KH and de Vries HJC Journal of the International AIDS Society 2019, 22(S6):e25357 http://onlinelibrary.wiley.com/doi/10.1002/jia2.25357/full | https://doi.org/10.1002/jia2.25357 EDITORIAL HIV and sexually transmitted infections: reconciling estranged bedfellows in the U = U and PrEP era Kenneth H Mayer1,2§ and Henry JC de Vries3,4 §Corresponding author: Kenneth H Mayer, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA. Tel: +1 617 927 087. ([email protected]) Keywords: HIV; STI; PrEP; primary prevention; secondary prevention; sexual behaviour Received 27 June 2019; Accepted 27 June 2019 Copyright © 2019 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. Since the earliest days of the AIDS epidemic, it was clear that were well known and well described. HIV clinical care involved HIV and other sexually transmitted infections (STI) had many treating individuals who were at risk for recurrent opportunis- features in common [1]. Their spread involved the same beha- tic infections and neoplasms, whereas STI management was viours, and often affected the same socially marginalized peo- able to focus on the development of systems to diagnose and ple, including men who have sex with men (MSM), sex treat infections, with much attention was devoted to identify- workers, substance users and migrants. As the aetiologic agent ing people who were HIV-infected and treating their intimate of AIDS, HIV, was elucidated, it became clearer that there contacts. Because of the dire illnesses that people living with were biological interactions between HIV and STI. Inflamma- HIV developed, and the rapid growth of the epidemic, a sense tory and ulcerative STI facilitated HIV transmission and acqui- of urgency led to funding dedicated siloed programmes, such sition, and HIV infection led to increased infectiousness of as the NIH clinical trials networks, the PEPFAR initiative and several STI pathogens [2,3]. A more sophisticated understand- the Global Fund, with scant consideration of concomitant STI ing of their epidemiology also suggested that individuals who that were frequently co-prevalent. Yet at the same time, STI were engaging in behaviours that led to STI acquisition were specialists who worked for decades with high disease burden more likely to be part of sexual networks where HIV transmis- populations found that support for their work was not sion or acquisition were more likely. Prior to the advent of expanding, and sometimes shrinking. The separation of HIV antiretrovirals for prevention, common strategies employed to and STI support through categorical funding further impeded decrease HIV/STI spread, mainly involved the promotion of fruitful collaborations [9,10]. “ABC”: Abstinence, or Behaviour change (decreasing the num- Over the past decade, the situation has been altered dra- ber of partners), and Condom use. matically because of the recognition that, although there are However, over the past decade, the evidence proving that now tools to control the HIV epidemic, without addressing people living with HIV who had undetectable plasma HIV RNA STI, their spread will accelerate, leading to widespread mor- do not transmit HIV (U = U) [4,5], and the demonstration that bidity, complicating HIV control efforts [9,10]. Increases in pre-exposure prophylaxis (PrEP) using tenofovir-based regi- congenital syphilis, expanding antimicrobial resistance in gono- mens protects individuals against the sexual acquisition of HIV cocci, and sexually transmitted Hepatitis C are three of many [6-8] has altered the dynamics of HIV-STI epidemiologic syn- examples of how the global public health community has come ergy. In the current era, individuals who are adherent to to recognize that without addressing STI, the successes in the antiretroviral medication, whether for treatment or preven- AIDS epidemic will be compromised. It is with that intent in tion, can expect to engage in condomless intercourse without mind that the International AIDS Society sponsored the STI either acquiring HIV or transmitting the virus to others, but 2018 pre-conference in Amsterdam in July, 2018. are still at high risk for acquiring and transmitting STI. More- The two-day meeting featured a variety of presentations over, during this same time period, STI increases have been that addressed the epidemiological, clinical, behavioural and occurring globally, particularly in key populations. structural issues that have driven the HIV and STI syndemics. Historically, HIV researchers, STI specialists and frontline Several key papers have been assembled for this special issue clinicians have had differing perspectives about the relation- of the Journal of the International AIDS Society which summa- ships between HIV and STI. In the earliest days of the epi- rize the key themes discussed at the conference, in order to demic, HIV research was focused on trying to identify an inform readers about the current state of the science related unknown, highly lethal pathogen, whereas most STI pathogens to HIV and STI interactions and to discuss challenges ahead 1 Mayer KH and de Vries HJC Journal of the International AIDS Society 2019, 22(S6):e25357 http://onlinelibrary.wiley.com/doi/10.1002/jia2.25357/full | https://doi.org/10.1002/jia2.25357 for a more integrated response to these syndemics. Taylor when individuals who are at high risk for HIV/STI utilize inter- and Wi of the WHO describe the global epidemiology of STI ventions that can protect them against HIV but not STI [18]. spread, and notably, their paper points out that more than The topic of emerging infectious diseases is discussed by Nij- one million treatable STI occur daily across the globe, in addi- meijer and colleagues, focusing primarily on Hepatitis C but tion to even larger numbers of chronic viral infections, like also discussing the potential of other agents that are not often Herpes simplex and Human papillomavirus [11]. Moreover, many thought of as being sexually transmitted to emerge when of these infections are prevalent in areas of high HIV inci- behavioural patterns change [19]. Rietmeijer discusses the dence, or among populations of greatest HIV risk, underscor- evolution of STI clinics in recent years, and their continued ing the need for combination approaches to address STI and need to change in order to optimally co-manage HIV and STI HIV. Wi and WHO colleagues describe the current status of [20]. Lastly, Rojas Castro and colleagues discuss the supreme clinical management of STI globally, noting the issues related importance of engaging affected communities in order to con- to the continued frequent use of empiric, syndromic manage- duct effective clinical research, to translate science into clinical ment [12].
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