Contribution of HIV-1 infection to acquisition of sexually transmitted disease: a 10-year prospective study.
BACKGROUND
Sexually transmitted diseases (STDs) enhance human immunodeficiency virus (HIV)-1 susceptibility, but few studies have examined the reciprocal effect of HIV-1 on STD acquisition.


METHODS
Data from a prospective cohort study conducted among female sex workers in Mombasa, Kenya between 1993 and 2003 were used to determine the effect of HIV-1 infection on STD susceptibility. The cohort included 1215 HIV-1-seronegative women who underwent monthly HIV-1 and STD screening, of whom 238 experienced seroconversion to HIV-1 during follow-up. Andersen-Gill proportional-hazards models were used to compare the incidence rates for genital-tract infections (syphilis, genital ulcer disease [GUD], Neisseria gonorrhoeae infection, Chlamydia trachomatis infection, Trichomonas vaginalis infection, vulvovaginal candidiasis, and bacterial vaginosis) in HIV-1-seropositive versus HIV-1-seronegative women, after controlling for sexual behavior and other potential confounding factors.


RESULTS
HIV-1 infection was associated with a significantly higher incidence of GUD (hazard ratio [HR], 2.8; 95% confidence interval [CI], 2.0-3.9), gonorrhea (HR, 1.6; 95% CI, 1.1-2.2), and vulvovaginal candidiasis (HR, 1.5; 95% CI, 1.3-1.8). The risks of GUD and vulvovaginal candidiasis increased with progressive levels of immunosuppression.


CONCLUSIONS
The increased incidence of genital-tract infections among HIV-1-seropositive women could promote the spread of both HIV-1 and other STDs, particularly in areas where these conditions are highly prevalent.
McClelland
R Scott
RS
Department of Medicine, University of Washington, Seattle, Washington 98104, USA. mcclell@u.washington.edu
Lavreys
Ludo
L
Katingima
Christine
C
Overbaugh
Julie
J
Chohan
Vrasha
V
Mandaliya
Kishorchandra
K
Ndinya-Achola
Jeckoniah
J
Baeten
Jared M
JM
D000328:Adult; D015331:Cohort Studies; D005260:Female; D005831:Genital Diseases, Female / Q000453:epidemiology / Q000209:etiology; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology / Q000635:transmission; D015497:HIV-1 / Q000502:physiology; D006801:Humans; D015994:Incidence; D007630:Kenya / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D011477:Sex Work; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000209:etiology / Q000635:transmission*