The association between Lymphogranuloma venereum and HIV among men who have sex with men: systematic review and meta-analysis

A systematic review was performed on the emergence of LGV among MSM since 2000. We report the prevalence of HIV infection from descriptive studies of MSM with LGV, and conduct a meta-analysis to produce a summary estimate of the association between LGV and HIV from case-control studies where cases were MSM with LGV and controls were MSM with rectal chlamydia caused by non-LGV serovars.The prevalence of HIV among LGV cases ranges from 67% to 100% in 13 descriptive studies. There is a significant association between HIV and LGV (odds ratio 8.19, 95% CI 4.68-14.33).HIV-positive MSM are disproportionately affected by LGV highlighting the importance of prevention efforts to be targeted to this group. Further research is needed to determine whether the association is due to biological or behavioural factors.Lymphogranuloma venereum (LGV) is a sexually transmitted infection (STI) which largely disappeared from the Western world after the introduction of antibiotics. LGV is caused by the species Chlamydia trachomatis (CT) which produces infection in humans and includes three biovars [1]; serovars A-C cause trachoma, an eye infection that mainly spreads via child-to-child transmission and is the leading cause of preventable blindness, while the second biovar (serovars D-K, and occasionally also B [2]) is transmitted sexually [3]. Serovars A-K have a limited host-cell range, they infect mainly squamocolumnar epithelial cells and are incapable of infecting deeper tissues. The third biovar, LGV, is formed by serovars L1, L2 and L3 and it causes a more invasive disease due to its ability to infect macrophages and consequently it can spread to lymphatic tissue at the site of infection leading to a systemic disease [4]. LGV is classified as a genital ulcer disease (GUD) without clear tissue tropism for mucosa contrary to non-LGV chlamydia, and it has been considered endemic in the tropics although LGV epidemiology in these areas has not been systematically described. In 2003 a clu