Scientists Explore Role of STDs, Malaria, and TB in Africa

The effect of HIV-1 on other infectious diseases in Africa is an increasing public health concern, according to a review in the June 22 edition of the Lancet ("HIV-1/AIDS and the Control of Other Infectious Diseases," 2002;359:2177-87). Elizabeth Corbett from the London School of Hygiene and Tropical Medicine, United Kingdom, and the Harare Biomedical Research and Training Institute, Zimbabwe, and colleagues describe the role that three major infectious diseases -- malaria, sexually transmitted diseases (STDs), and tuberculosis -- have had in the HIV-1 epidemic.

The high prevalence of untreated STD infections has been a major factor facilitating the spread of HIV-1 in Africa, with the synergistic interaction between HIV-1 transmission and genital herpes being of special concern for control of both diseases. Increased susceptibility to TB after infection with HIV-1 has led to a rising incidence and threat of increased transmission of TB. Clinical malaria occurs with increased frequency and severity in HIV-1-infected individuals, especially during pregnancy. As with TB, STDs, and other communicable HIV-1-associated diseases, the net effect of HIV-1 might include increased rates of malaria transmission across communities.

"The HIV-1 epidemic in Africa has reached such an extreme magnitude that further major consequences are inevitable, and will include increasing difficulty in controlling other infectious diseases," said Corbett. "One of the cruel ironies is that the severity of the African HIV-1 epidemic is in itself a direct reflection of the impoverished and imperfect nature of health care that preceded the epidemic, notably poor control of STDs. Improvements were made in infectious disease control in Africa during the last half of the 20th century, but to a limited extent that left endemic disease and transmission rates well above those of more developed countries. HIV-1 has now so compounded this situation that it would take a massive scale of interventions to return regional health to pre-epidemic standards. Without intervention, however, public health will become more difficult and expensive to maintain since the incidence, transmission, and drug resistance of other endemic diseases are affected by HIV-1."

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