Public health specialists and HIV experts say it is time to treat HIV and sexually transmitted infections (STIs) under one roof and not in silos, following findings that almost one-sixth of HIV infections among STI patients are new infections.

According to a study by Wits University and the University of Cape Town, recent HIV infection was independently associated with acute genital ulceration or ulcers among the HIV-positive people compared to HIV-negative individuals.

Those who had been infected with HIV over the long-term did not have these symptoms.

Researchers analysed antiretroviral therapy use, HIV positivity, viral suppression and recency of HIV infection among patients with STIs at two clinics in Gauteng and the Western Cape.

They found that even though many of the 450 patients who took part were HIV-negative, they were at high risk of acquiring HIV infection due to symptoms such as genital tract inflammation, ulcers and untreated STIs.

Genital inflammation and STIs not only lead to local recruitment of CD4 cells, which are target cells for HIV, disruption associated with ulcerative genital infection facilitates HIV entry, leading to increased susceptibility.

Public health experts argue that even though SA has halved its infections in the last decade, the decrease is not sufficient to meet global HIV prevention targets.

Therefore, better integration of HIV and STI prevention and treatment services is needed to accelerate progress towards the goal of zero new HIV infections.

In the study, which appears in the South African Medical Journal, researchers suggest services such as medical male circumcision, injectable ARVs, pre-exposure prophylaxis (PrEP), HIV testing and counselling should be expanded among those treated for STIs.

The new findings strengthen existing research that has linked high inflammation levels of genitalia with HIV acquisition.

Of 451 symptomatic patients with active STIs, about 20% were HIV-positive. At least 16% were recently infected. Recent infection was associated with genital ulcer disease at presentation.

About 84% of those with HIV had a long-term infection but researchers found only 38.5% were on antiretrovirals. Only 77% of those on antiretrovirals were virally suppressed.

Lead researcher Tendesayi Kufa, an epidemiologist at the National Institute for Communicable Diseases, said even though the study was small and its findings had limitations, “it serves as a reminder of the value of STI services as a platform for identifying newly infected individuals”.

She added: “It is important to improve the effectiveness of ART as HIV prevention in those who are already HIV-infected by ensuring viral load suppression among all on treatment, while identifying individuals at risk of HIV acquisition.

“Given the high burden of recent HIV infection, which may suggest a high incidence in the catchment population of the sentinel clinics, pre-exposure prophylaxis (PrEP) services should be urgently integrated into STI services.”

TimesLIVE