HIV, STIs and Co-infections

39.0 million people globally were living with HIV in 2022. And 1.3 million people became newly infected with HIV in 2022 (UNAIDS). Globally, there were 1.2 million pregnant women with HIV in 2022. HIV infection remains a major public health issue and a significant cause of suffering and death. Globally 46% of all new HIV infections were among women and girls (all ages) in 2022.

Furthermore, without appropriate prophylaxis, HIV can be passed from mother to child at birth. Treatment through anti-retrovirals (ARV) can significantly suppress the virus and is currently available to almost three quarters of those living with the virus.

Co-Infections and Complications

HIV, viral hepatitis and sexually transmitted infections collectively cause 2.3 million deaths and 1.2 million cases of cancer each year (WHO 2022).

Co-infection means not only does the individual suffer the symptoms of both diseases, but in many cases one disease can amplify the progression of the other. For example a woman with both HIV and Hepatitis C is estimated to be more likely (3-4 times more likely) to transmit Hepatitis C to the unborn baby than if they had only Hepatitis C (CDC).

It has been estimated that around 2.3 to 7 million people are globally co-infected with HIV/HCV. Recent studies put the odds of HCV infection are six times higher in people living with HIV (PLWH).

Similarly, those infected with HIV are also at risk of Hepatitis B infection. Compared with individuals with HBV infection alone, people with HIV/HBV coinfection can experience an accelerated progression of liver disease. A pregnant woman infected with HIV and/or Hepatitis B has a very high probability of infecting the baby at birth unless specific action is taken.

Syphilis is a third major co-infection with HIV. The presence of syphilis, caused by a bacterium called Treponema pallidum increases the odds of HIV infection. In 2020, WHO estimated that 7.1 million adults aged 15–49 acquired syphilis globally.

Syphilis in pregnancy, when not treated, treated late or treated with the incorrect antibiotic, results in 50−80% of cases with adverse birth outcomes. Congenital syphilis is also the second leading cause of preventable stillbirth globally, preceded only by malaria (WHO).

Transmission Prevention

Put simply, early detection of HIV, syphilis, Hepatitis B and Hepatitis C means the opportunity to treat the infection(s) before the onset of more serious symptoms. It also means the likely prevention of one or more co-infections in adults.

For infants, the prevention of transmission is imperative. Early pregnancy is an opportune time to diagnose a woman, and improve her health while also preventing what is called the vertical transmission from mother to child.

As the Hepatitis B Foundation states, “there is no second chance to protect an infant once this window of opportunity is missed.” An infant whose mother is diagnosed with HIV or Hepatitis B, Hepatitis C or syphilis must receive prophylaxis or be treated immediately.

Partnerships and Collaborations

Maternova and MedMira have partnered to bring a set of vertical flow rapid tests more rapidly in multiple geographies. These tests are unique in that they are multiplexed (they can test for multiple infections simultaneously) with a simple, clear readout.

Of utmost importance is the speed and specificity of the readout. The MedMira tests show results in well under three minutes, which is critically important for making fast decisions, while the patient is still present. Working together, MedMira and Maternova are ensuring that testing at the point of care is feasible, affordable and efficient.

Policy and Guidelines

The World Health Organization is focused on a common goal towards elimination of Hepatitis B, syphilis and HIV. “Triple Elimination” is an example of an initiative targeting all 3 diseases.

Global health sector strategies on, respectively, HIV, viral hepatitis and sexually transmitted infections for the period 2022-2030
https://www.who.int/publications/i/item/9789240053779

The global elimination of congenital syphilis: rationale and strategy for action
https://www.who.int/publications/i/item/9789241595858

FAQs

Is it effective to try to prevent transmission of HIV from mother to child?

Preventing the transmission of HIV from mother to child works. It is cost-effective.

Is it possible to completely eliminate the transmission of HIV and syphilis from mother to child?

Yes it is possible to completely eliminate the transmission of HIV and syphilis.

Conclusion

Early detection of HIV, syphilis and Hepatitis B and C are critical to reducing transmission in the general population and to initiating treatment for the infected individual.