EPIDEMIOLOGIC SYNERGY - INTERRELATIONSHIPS BETWEEN HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION AND OTHER SEXUALLY-TRANSMITTED DISEASES - (REPRINTED FROM AIDS AND WOMENS REPRODUCTIVE HEALTH, CH 5, 1992)

Understanding the role of other sexually transmitted diseases (STDs) i n the transmission of human immunodeficiency virus (HIV), the role of STDs in progression of HIV disease, and the role of HIV infection in a lterations of natural history, diagnosis, or response to therapy of ST Ds is critical to the development of optimal strategies for HIV contro l. One hundred sixty-three studies on the interrelationships between H IV infection and other STDs were examined. Of 75 studies on the role o f STDs in HIV transmission, the 15 analyses of examination or laborato ry evidence of STDs adjusted for sexual behavior showed that both ulce rative and nonulcerative STDs increase the risk of HIV transmission ap proximately 3- to 5-fold. Due to limited data, the role of STDs in pro gression of disease remains unclear. Preliminary data from 83 reports on the impact of HIV infection on STDs suggest that, at a community le vel, HIV infection may increase the prevalence of some STDs (e.g., gen ital ulcers). If coinfection with HIV prolongs or augments the infecti ousness of individuals with STDs, and if the same STDs facilitate tran smission of HIV, these infections may greatly amplify one another. Thi s "epidemiological synergy" may be responsible for the explosive growt h of the HIV pandemic in some populations. Effective STD control progr ams will be essential to HIV prevention in these communities.