A Systematic Review and Meta-analysis of Risk Factors for Sexual Transmission of HIV in India

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2012 Sep 1

PMID 22937158

Citations 11

Authors

Paul Arora

Nico J D Nagelkerke

Prabhat Jha

Affiliations

Soon will be listed here.

Abstract

Background: Approximately 2.4 million people are living with HIV in India. This large disease burden, and potential for epidemic spread in some areas, demands a full understanding of transmission in that country. We wished to quantify the effects of key sexual risk factors for HIV infection for each gender and among high- and low-HIV risk populations in India.

Methodology: We conducted a systematic review of sexual risk factors for HIV infection from 35 published studies. Risk factors analyzed were: male circumcision/religion, Herpes Simplex Virus 2, syphilis, gonorrhoea, genital ulcer, multiple sexual partners and commercial sex. Studies were included if they met predetermined criteria. Data were extracted and checked by two researchers and random-effects meta analysis of effects was conducted. Heterogeneity in effect estimates was examined by I(2) statistic. Publication bias was tested by Begg's test and funnel plots. Meta regression was used to assess effect modification by various study attributes.

Results: All risk factors were significantly associated with HIV status. The factor most strongly associated with HIV for both sexes was HSV-2 infection (OR(men): 5.87; 95%CI: 2.46-14.03; OR(women): 6.44; 95%CI: 3.22-12.86). The effect of multiple sexual partners was similar among men (OR = 2.46; 95%CI: 1.91-3.17,) and women (OR = 2.02; 95%CI: 1.43-2.87) and when further stratified by HIV-risk group. The association between HSV-2 and HIV prevalence was consistently stronger than other STIs or self-reported genital ulcer. If the strong associations between HSV-2 and HIV were interpreted causally, these results implied that approximately half of the HIV infections observed in our study population were attributable to HSV-2 infection.

Conclusions: The risk factors examined in our analysis should remain targets of HIV prevention programs. Our results confirm that sexual risk factors for HIV infection continue to be an important part of Indian HIV epidemic 26 years after it began.

Citing Articles

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Agathis N, Annor F, Xu L, Swedo E, Chiang L, Coomer R Int J Environ Res Public Health. 2023; 20(14).

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Male circumcision and Sexually transmitted Infections - An update.

Mehta K, Marfatia Y, Jain A, Shah D, Baxi D Indian J Sex Transm Dis AIDS. 2021; 42(1):1-6.

PMID: 34765930 PMC: 8579597. DOI: 10.4103/ijstd.ijstd_20_21.

Effect of syphilis infection on HIV acquisition: a systematic review and meta-analysis.

Wu M, Gong H, Hu K, Zheng H, Wan X, Li J Sex Transm Infect. 2020; 97(7):525-533.

PMID: 33219164 PMC: 8543214. DOI: 10.1136/sextrans-2020-054706.

HIV prevalence correlated with circumcision prevalence and high-risk sexual behavior in India's states: an ecological study.

Kenyon C F1000Res. 2019; 8:60.

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Effectiveness of female condom in preventing HIV and sexually transmitted infections: a systematic review protocol.

Mome R, Wiyeh A, Kongnyuy E, Wiysonge C BMJ Open. 2018; 8(8):e023055.

PMID: 30082362 PMC: 6078242. DOI: 10.1136/bmjopen-2018-023055.

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