title: Increased risk of genital ulcer disease in women during the first month after initiating antiretroviral therapy.
abstract: 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.
authors: Departments of Medicine, Epidemiology and Global Health, University of Washington, Seattle, WA 98104-2499, USA. grahamsm@u.washington.edu
authors: Susan M
authors: SM
authors: Graham
authors: Linnet
authors: L
authors: Masese
authors: Ruth
authors: R
authors: Gitau
authors: Dickson
authors: D
authors: Mwakangalu
authors: Walter
authors: W
authors: Jaoko
authors: Jeckoniah
authors: J
authors: Ndinya-Achola
authors: Kishor
authors: K
authors: Mandaliya
authors: Norbert
authors: N
authors: Peshu
authors: Jared M
authors: JM
authors: Baeten
authors: R Scott
authors: RS
authors: McClelland
mesh_terms: 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
chemical_list: D019380:Anti-HIV Agents