title: Elevated urinary leukocyte esterase as a potential surrogate marker for HIV sexual transmission risks in men receiving antiretroviral therapy.
abstract: Local genital tract inflammation stimulates leukocyte activity and causes HIV shedding, potentially increasing HIV sexual infectiousness. Although there are available clinical markers for genital tract inflammation, such as urinary leukocyte esterase, none have yet been examined in relation to HIV sexual risk behaviours. We sought to examine the association between urinary leukocyte esterase and sexual practices. Sexually active men living with HIV and receiving antiretroviral therapy (ART, N = 290) provided urine specimens and completed behavioural health assessments. HIV RNA tests and CD4 cell counts were abstracted from medical records. Urine specimens were analysed for leukocyte esterase using a standard point-of-care dipstick test. Thirty-one (10.6%) participants tested positive for leukocyte esterase. Logistic regression models did not indicate differences between men with elevated and un-elevated leukocyte activity on demographic, health, recent sexually transmitted infection symptoms and diagnoses or substance use. However, men with elevated leukocyte activity indicated significantly greater sexual behaviour in the previous three months, including more recent unprotected sexual intercourse. A simple over-the-counter urine test may serve as an indicator of sexual HIV infectiousness to inform further evaluation and treatment of genital tract inflammation, as well as condom use decisions during times of increased genital tract inflammation.
authors.affiliation: Department of Psychology, University of Connecticut, Storrs, CT, USA seth.k@uconn.edu.
authors.forename: Seth C
authors.initials: SC
authors.lastname: Kalichman
authors.affiliation: Department of Psychology, University of Connecticut, Storrs, CT, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Washington
authors.affiliation: Department of Psychology, University of Connecticut, Storrs, CT, USA.
authors.forename: Tamar
authors.initials: T
authors.lastname: Grebler
authors.affiliation: Department of Psychology, University of Connecticut, Storrs, CT, USA.
authors.forename: Moira O
authors.initials: MO
authors.lastname: Kalichman
authors.affiliation: Department of Psychology, University of Connecticut, Storrs, CT, USA.
authors.forename: Chauncey
authors.initials: C
authors.lastname: Cherry
authors.affiliation: Department of Psychology, University of Connecticut, Storrs, CT, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Eaton
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015415:Biomarkers; D018791:CD4 Lymphocyte Count; D002265:Carboxylic Ester Hydrolases / Q000652:urine*; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012306:Risk; D012309:Risk-Taking; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012747:Sexual Partners; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000635:transmission*
chemical_list: D019380:Anti-HIV Agents; D015415:Biomarkers; C021443:leukocyte esterase; D002265:Carboxylic Ester Hydrolases
keywords: AIDS; HIV; HIV transmission risks; genital tract inflammation; men; sexually transmitted infections; treatment as prevention; urinary leukocyte esterase; urine dipstick