Accounting for HIV and rectal gonorrhea can help make PrEP more effective

The results of a study conducted by a group of scientists from the United States showed a correlation between the frequency of rectal gonorrhea and HIV infection among men who have sex with men who do not use pre-exposure prophylaxis (PrEP). According to the researchers, the findings suggest that the incidence of rectal gonorrhea may serve as a potential predictor of HIV incidence. This discovery, they said, could be the basis for future PrEP research in order to increase the effectiveness of virus prevention.

“Our article, based on an analysis of published literature, is a potential confirmation of the concept of the relationship between the incidence of HIV infection and rectal gonorrhea in men who have sex with men (MSM),” said group leader Dr. Jeffrey S. Murray.

“In the case of a more complete study with other evidence supporting the conclusion, we could use it as a tool to develop [more effective means] for HIV prevention. [Our conclusion is] an estimate of the HIV incidence rate, provided that test participants do not receive PrEP. ”

It has been proven that PrEP has high efficacy while reducing the incidence of HIV - this is undoubtedly “a tremendous achievement of health care,” says Dr. Murray. However, this does not remove the issue of the prevention of the virus itself and “sets us the task of further increasing the effectiveness of PrEP”.

According to the specialist, in key groups, HIV and rectal gonorrhea are “side by side”. Especially for the study, Dr. Murray and co-author Dr. Charu Mallik, a senior medical officer at the FDA anti-virus product department, searched PubMed for available literature using the search terms “gonorrhea” and “HIV”. The analysis included only studies published no earlier than 2000 with the participation of HIV-negative MSM who did not take PrEP and did not have rectal gonorrhea and HIV during the same observation period.

The final analysis included eight studies from 2000 to 2016. Overall, the incidence of rectal gonorrhea ranged from 1.7 / 100 person-years to 33/100 person-years, while the incidence of HIV ranged from 0.9 / 100 person-years to 9/100 person-years.

Mallick and Murray concluded that there is a “strong correlation” between rectal gonorrhea and HIV incidence (Pearson correlation = 0.94; CI 95%, 0.68–0.99).

Using data from eight studies of the association of HIV infection and rectal gonorrhea, scientists have developed a prognostic model of the incidence of HIV infection, which can potentially be used to assess risky sexual behavior in PrEP studies.

“Our goal in preparing this material was to increase the interest of specialists to further analyze the links between [rectal gonorrhea] and other sexually transmitted infections and HIV using additional cohorts, as well as to conduct research aimed at increasing the effectiveness of PrEP tests” - the authors summarized.