title: Female to male transmission of human immunodeficiency virus type 1: risk factors for seroconversion in men.
abstract: To determine the frequency and risk factors for female to male sexual transmission of human immunodeficiency virus type 1 (HIV-1), a prospective study was carried out in 422 men who had acquired a sexually transmitted disease (STD) from a group of prostitutes with a prevalence of HIV-1 infection of 85%. The initial seroprevalence of HIV among the men was 12%. 24 of 293 (8.2%) initially seronegative men seroconverted to HIV-1. Newly acquired infection was independently associated with frequent prostitute contact (risk ratio 3.2, 95% confidence interval 1.2-8.1), with the acquisition of genital ulcer disease (risk ratio 4.7, 95% confidence interval 1.3-17.0), and with being uncircumcised (risk ratio 8.2, 95% confidence interval 3.0-23.0). 96% of documented seroconversions occurred in men with one or both of the latter two risk factors. In a subgroup of 73 seronegative men who reported a single prostitute sexual contact, the frequency of HIV-1 infection was 8.2% during 12 weeks of observation. No man without a genital ulcer seroconverted. A cumulative 43% of uncircumcised men who acquired an ulcer seroconverted to HIV-1 after a single sexual exposure. These data indicate an extremely high rate of female to male transmission of HIV-1 in the presence of STD and confirm a causal relation between lack of male circumcision, genital ulcer disease, and susceptibility to HIV-1 infection.
authors.affiliation: Department of Medical Microbiology, University of Nairobi, Kenya.
authors.forename: D W
authors.initials: DW
authors.lastname: Cameron
authors.forename: J N
authors.initials: JN
authors.lastname: Simonsen
authors.forename: L J
authors.initials: LJ
authors.lastname: D'Costa
authors.forename: A R
authors.initials: AR
authors.lastname: Ronald
authors.forename: G M
authors.initials: GM
authors.lastname: Maitha
authors.forename: M N
authors.initials: MN
authors.lastname: Gakinya
authors.forename: M
authors.initials: M
authors.lastname: Cheang
authors.forename: J O
authors.initials: JO
authors.lastname: Ndinya-Achola
authors.forename: P
authors.initials: P
authors.lastname: Piot
authors.forename: R C
authors.initials: RC
authors.lastname: Brunham
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology / Q000276:immunology / Q000635:transmission*; D000208:Acute Disease; D000328:Adult; D002944:Circumcision, Male; D015331:Cohort Studies; D004198:Disease Susceptibility; D005260:Female; D005832:Genital Diseases, Male / Q000150:complications; D015483:HIV Antibodies / Q000032:analysis; D006679:HIV Seropositivity / Q000276:immunology; D006801:Humans; D007630:Kenya; D008297:Male; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D012737:Sex Factors; D011477:Sex Work; D014456:Ulcer / Q000150:complications
chemical_list: D015483:HIV Antibodies