Journal Article

Determinants of HIV Type 1 Shedding from Genital Ulcers among Men in South Africa

Gabriela Paz-Bailey, Maya Sternberg, Adrian J. Puren, Lisa Steele and David A. Lewis

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 50, issue 7, pages 1060-1067
Published in print April 2010 | ISSN: 1058-4838
Published online April 2010 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/651115
Determinants of HIV Type 1 Shedding from Genital Ulcers among Men in South Africa

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  • Infectious Diseases
  • Immunology
  • Public Health and Epidemiology
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Background

Our study evaluated correlates of human immunodeficiency virus (HIV)-1 lesional shedding among men with genital ulcer disease (GUD).

Methods

Participants were recruited at primary health care clinics as part of a randomized trial of episodic acyclovir among men with GUD. This analysis was done among HIV-positive men identified at baseline. Participants were serologically screened for HIV infection, syphilis, and herpes simplex virus type 2 infection and for urethritis and ulcer etiology by polymerase chain reaction. Plasma and genital ulcer HIV-1 loads and CD4 cell counts were quantified. We evaluated variables associated with the presence and quantity of HIV-1 in ulcers.

Results

Among 387 HIV-positive men, the median plasma HIV-1 load and CD4 cell count were 87,200 copies/mL and 282 cells/mm3. Overall, 173 (45.6%) had detectable HIV-1 RNA in ulcers. Men with Trichomonas vaginalis infection had higher ulcer viral loads on average than did those who were not infected (mean difference, 0.62; 95% confidence interval [CI], 0.07–1.2; P = .027). After multivariable analysis, higher plasma HIV-1 load (odds ratio [OR], 2.5; 95% CI, 1.7–3.5; P<.001 ), larger lesions (OR, 2.5; 95% CI, 1.5–4.1; P<.001 ), purulent ulcers (OR, 2.2; 95% CI, 1.1–4.2; P = .02), multiple ulcers (>5; OR, 3.6; 95% CI, 1.6–8.4; P = .002), and herpes seropositivity (OR, 3.4; 95% CI, 1.7–7.0; P<.001 ) remained associated with increased odds of HIV-1 lesional shedding. Ulcers associated with herpes simplex virus type 2 infection were less likely to shed (OR, 0.6; 95% CI, 0.3–1.0; P = .05), compared with ulcers with unknown etiology.

Conclusions

HIV-positive men should be screened and treated for GUD to minimize HIV shedding and transmission to uninfected sexual partners.

Journal Article.  5447 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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