Nobody needs convincing of the huge impact of HIV in our world today. While the prevalence of HIV differs vastly by region of the world, it still touches nearly every corner of the earth and has caused devastation throughout the span of its pandemic. There are an estimated 35 million people living with HIV today, and while the number of mortalities per year has fallen in recent years, it remains above one million. While these numbers are difficult to see, they are unlikely a surprise to most. The HIV pandemic is one of the most researched, targeted, and widely discussed. Much less discussed is the interaction HIV can have with other infectious diseases, and how coinfection can amplify the effects of disease.
Coinfection is defined as infection with more than one disease at the same time. The impact of coinfection with HIV is especially significant due to where HIV is most prevalent: Sub-Saharan Africa. Sub-Saharan Africa, home to the highest rates of HIV in the world, is also home to the greatest risk for an array of other infectious diseases. This has very specific implications for HIV positive individuals. HIV weakens the immune system, leaving individuals more susceptible to contracting other diseases. Once infected, coinfection can amplify the effects of both diseases and speed up the progression of disease, worsening health outcomes to an even more extreme degree. Schistosomiasis and syphilis are both closely tied to HIV, which will now be discussed in more detail.
Schistosomiasis, also known as the disease of poverty, has been a topic of interest for our research at Maternova recently. It is acquired through contact with fresh water infected with parasitic blood flukes called schistosomes. While virtually unheard of in the United States, schistosomiasis affects around 240 million people globally, 90% of which are in Africa. Symptoms generally begin with fever, cough, diarrhea, abdominal pain, and rashes, but if left untreated can evolve into chronic schistosomiasis. This can lead to permanent organ damage and is the cause of over 200 thousand deaths per year. In terms of the relationship with HIV, infected individuals are more susceptible to HIV acquisition. If the coinfection already exists, HIV progresses more rapidly through greater viral replication and immunosuppression. It also increases the likelihood of transmission of HIV both vertically and horizontally. While treatment of schistosomiasis has been identified as a prevention measure for those at risk of HIV/AIDS, significant progress must be made in addressing this intersection of diseases.
The link between Syphilis and HIV may be more obvious because they are both sexually transmitted diseases. The symptoms of early stages of syphilis are painless sores which can evolve to rashes, and sometimes flu-like feelings. If left untreated, however, syphilis can cause paralysis, organ damage, and death. While the relationship between HIV and syphilis is complex, syphilis has been proven to increase the risk of HIV acquisition. The immune system is important in protecting against syphilis, so those with HIV are more susceptible to syphilis as well. Evidence has also shown that syphilis progresses more rapidly in HIV positive individuals. Diagnosis may be further complicated as well, because one infection leads to both more false-negatives and false-positives when testing for the other. Finally, treatment difficulties can arise; there have been cases of one disease altering the progression of the other, so standard treatment is less reliable.
Syphilis and schistosomiasis are only two of a vast number of diseases that interact with and affect HIV. Other common coinfections are tuberculosis, hepatitis B, hepatitis C, and malaria. Coinfection is an area with untapped potential for insight into shortcomings in treatment and prevention. The effects of prevention efforts can be amplified if they both prevent one disease and prevent the acceleration of HIV/AIDS progression. Diseases do not occur in isolation from one another, and treatment efforts should not either. Moving forward, it is especially important that prevention measures are targeted at populations at increased risk for multiple infectious diseases. Not only will this combat disease in vulnerable populations, but combat the especially devastating effects of coinfection.
Maternova is now offering rapid diagnostic tests for HIV, Hepatitis B, Hepatitis C, syphilis, and many other sexually transmitted diseases.