Increased risk of genital ulcer disease in women during the first month after initiating antiretroviral therapy.
BACKGROUND
Genital ulcer disease (GUD) is common in HIV-1-infected women, and a small number of studies have suggested increased GUD risk after antiretroviral therapy (ART) initiation. To better define this risk, we monitored 134 women at ART initiation and monthly thereafter.


METHODS
Women were evaluated monthly for genital ulcers. Syphilis serology was tested quarterly, and chancroid culture was performed on ulcers that were felt to be clinically consistent with a diagnosis of chancroid. A logistic model with generalized estimating equations was used to analyze predictors of GUD from baseline until 6 months after ART initiation.


RESULTS
During the study period, GUD occurred in 54 women (40.3%) at 85 visits (10.0%). GUD prevalence was 9.7% at baseline, increased to 16.7% at month 1 [adjusted odds ratio (aOR) 1.9 (1.0-3.6), P = 0.04], then decreased to 6.4% by month 6. History of GUD [aOR 3.8 (1.9-7.7), P < 0.001) and CD4 count <100 [aOR 1.8 (1.0-3.4), P = 0.06] were associated with increased risk of GUD after ART initiation.


CONCLUSIONS
Women experience increased risk of GUD in the first month after ART initiation, particularly if they have low CD4 counts or a history of GUD.
Graham
Susan M
SM
Departments of Medicine, Epidemiology and Global Health, University of Washington, Seattle, WA 98104-2499, USA. grahamsm@u.washington.edu
Masese
Linnet
L
Gitau
Ruth
R
Mwakangalu
Dickson
D
Jaoko
Walter
W
Ndinya-Achola
Jeckoniah
J
Mandaliya
Kishor
K
Peshu
Norbert
N
Baeten
Jared M
JM
McClelland
R Scott
RS
D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D005831:Genital Diseases, Female / Q000453:epidemiology* / Q000276:immunology; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology; D015497:HIV-1; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D014456:Ulcer / Q000453:epidemiology* / Q000276:immunology
D019380:Anti-HIV Agents