Abstract
The gastrointestinal mucosa is a target of many sexually transmitted infections, and major advances have increased our understanding of the consequences of such infections within the gastrointestinal system. HIV-1 is associated with a marked loss of mucosal CD4+ T cells that express CC-chemokine receptor 5. This process seems to be more rapid and more severe in mucosa-associated lymphoid tissue than in the peripheral blood. Mechanistic insights into the underlying cause of acute and chronic gastrointestinal damage with HIV infection—microbial translocation, defects in intestinal epithelial barrier function and activation of a systemic immune response—have also been achieved. Increased understanding of the pathogenesis of mucosal HIV-1 infection may identify therapeutic targets to restore immunological function and the integrity of the intestinal mucosal epithelial barrier. The increasing prevalence of lymphogranuloma venereum in Europe, mostly in HIV-positive men who have sex with men, suggests a change in the epidemiology of what was previously considered to be a 'tropical' disease. The increasing incidence of acute HCV infection transmitted via sexual contact has also been fuelled by high-risk sexual behaviors among men who have sex with men, many of whom are also HIV-positive. The first part of this Review discusses the pathogenesis and gastrointestinal complications of HIV infection, and the second part summarizes advances in our understanding of other sexually transmitted infections of the gastrointestinal system.
Key Points
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A rapid depletion of CD4+ T cells that express CC-chemokine receptor 5 in gastrointestinal mucosa leads to the immunodeficiency that is characteristic of simian immunodeficiency virus (SIV)-infected macaques and HIV-infected individuals
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Loss of CD4+ T cells occurs more rapidly and more severely in the lymphoid tissue of the intestinal mucosa than in peripheral blood and secondary lymphoid organs after infection with SIV or HIV
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Microbial translocation, intestinal epithelial barrier damage and release of proinflammatory cytokines may contribute to the chronic immune activation of pathogenic HIV and SIV infections
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Outbreaks of lymphogranuloma venereum worldwide affect mostly HIV-positive men who have sex with men (MSM) and may facilitate the transmission of HIV
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A surge in the incidence of shigellosis among MSM parallels an increase in high-risk sexual behaviors that transmits HIV and other infections
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HCV is emerging as a sexually transmitted infection among HIV-positive MSM and is associated with risk factors for permucosal transmission including traumatic sexual practices
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Ng, S., Gazzard, B. Advances in sexually transmitted infections of the gastrointestinal tract. Nat Rev Gastroenterol Hepatol 6, 592–607 (2009). https://doi.org/10.1038/nrgastro.2009.143
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DOI: https://doi.org/10.1038/nrgastro.2009.143
