HIV-1 DNA shedding in genital ulcers and its associated risk factors in Pune, India

Abstract

HIV infection status was determined in 302 consecutive patients with genital ulcer disease (GUD) presenting to two sexually transmitted disease (STD) clinics in Pune, India. Of the 71 (24%) individuals with HIV infection, 67 (94%) were HIV antibody-positive, and 4 (6%) were HIV antibody-negative but p24 antigen-positive at the time of presentation. HIV-1 DNA was detected in 24 (34%) specimens. The genital ulcers of all four acutely infected p24-antigenemic subjects were HIV-1 DNA-positive by polymerase chain reaction (PCR) assay, compared with 20 of 67 (30%) seropositive patients (p = .01). Presence of chancroid, GUD symptoms for > 10 days, and concurrent diagnosis of cervicitis or urethritis were significantly associated risk factors for HIV-1 DNA shedding in ulcers. Early GUD diagnosis and aggressive treatment of HIV-infected patients may significantly reduce secondary transmission of HIV to other sex partners.

PIP: Genital ulcer disease (GUD) has been associated with an increased risk of HIV infection and transmission. The present study investigated HIV status in 302 consecutive patients with GUD presenting to two sexually transmitted disease (STD) clinics in Pune, India, in a 3-month period in 1994. 71 patients (24%) were HIV-positive; 4 (6%) of these patients were HIV-antibody negative but p24 antigen-positive. HIV-1 DNA was present in 24 specimens (34%). The genital ulcers of all 4 acutely infected p24 antigenemic subjects were HIV-1 DNA-positive by polymerase chain reaction assay compared with 20 (30%) of HIV antibody-positive patients. Significant risk factors for HIV-1 DNA shedding in ulcers were presence of chancroid (adjusted odds ratio (OR), 4.78; 95% confidence interval (CI), 1.15-19.9), GUD symptoms for more than 10 days (adjusted OR, 4.54; 95% CI, 1.19-17.3), and concurrent diagnosis of cervicitis or urethritis (adjusted OR, 9.35; 95% CI, 2.30-38.0). The finding of HIV-1 DNA in all 4 patients with acute primary HIV infection may be related to the high degree of circulating viremia present in acute infection. Early GUD diagnosis and aggressive treatment, especially of chancroid, in HIV-infected patients may significantly reduce secondary transmission of HIV to sexual partners.