AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #127 - Rush to judgment: Evidence from STI-HIV trials is not conclusive
Authors: Presenting Author: Prof Eileen Stillwaggon - Gettysburg College
Additional Authors: Prof. Larry Sawers,
Aim: Epidemiological and laboratory evidence suggests that bacterial and viral STIs promote the spread of HIV. Nine randomly controlled trials examined the effect of prevention and treatment programs on HIV incidence and only one has shown a statistically significant effect.
Method / Issue: We conducted a systematic review of all nine trials to determine their comparability and their applicability to the question of whether STI treatment can slow the spread of HIV.
Results / Comments: Problems in the eight trials that to do not find an effect are 1) all of the trials lack a true control arm, 2) none of the trials measure changes in incidence, 3) all of the trials were confounded by untreated genital ulcer disease, 4) none of the trials measured both transmission and acquisition, 5) at least four trials were confounded by changes in risky sexual behavior, 6) some trials lacked statistical power, 7) one trial failed to produce expected reductions in STI prevalence in the intervention arm, 8) one trial had large declines in STI prevalence in both control and intervention arms, 9) all of the trials were very complex, making it difficult to ascertain the effect of specific interventions, 10) one trial had high levels of non-compliance, and 11) three trials had possible incorrect medication and/or dosage.
Discussion: Eight trials could not find statistically significant differences in HIV incidence between control and intervention arms, but that does not support the conclusion that STI prevention and treatment programs do not slow the spread of HIV. More trials are needed that deal with issues raised in this review, although ethical requirements may preclude strict implementation of controls. Results of these eight trials are not conclusive evidence that improving genital health is unrelated to HIV prevention and should not stand in the way of strenuous efforts to improve genital health in sub-Saharan Africa.
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