title: Genital Cytomegalovirus Replication Predicts Syphilis Acquisition among HIV-1 Infected Men Who Have Sex with Men.
abstract: OBJECTIVE
  Sexually transmitted infections (STI) are common among HIV-infected men who have sex with men (MSM). While behavioral factors are important in STI acquisition, other biological factors such as immune modulation due to chronic viral infection may further predispose to STI acquisition.
  
  
  METHODS
  Post Hoc analysis including data collected over 12 months of follow-up from 131 HIV-infected MSM receiving antiretroviral therapy and screened for incident bacterial STI every 3 months.
  
  
  METHODS
  Genital secretions collected at baseline were used to measure herpesvirus replication and inflammatory cytokines. Baseline predictors of STI were determined using survival analysis of time to incident STI.
  
  
  RESULTS
  All participants were seropositive for cytomegalovirus (CMV), and 52% had detectable genital CMV at baseline. Thirty-five individuals acquired STI during follow-up, sometimes with multiple pathogen (17 syphilis, 21 gonorrhea, 14 chlamydia). Syphilis acquisition was associated with genital CMV replication at baseline (19.1% CMV-shedders versus 4.8% non-shedders, p=0.03) and younger age (p=0.02). Lower seminal MCP-1 was associated with higher seminal CMV levels and with syphilis acquisition (p<0.01). For syphilis acquisition, in multivariable Cox-Proportional Hazard model adjusted hazard rates were 3.56 (95%CI:1.00-12.73) for baseline CMV replication and 2.50 (0.92-6.77) for younger age.
  
  
  CONCLUSIONS
  This post hoc analysis suggest that CMV-associated decrease in seminal MCP-1 levels might predispose HIV-infected MSM to syphilis acquisition, but not other STI. Future studies should determine underlying mechanisms and if a causal association exists.
authors.affiliation: University of California, San Diego, La Jolla, California, United States of America.
authors.forename: Sara
authors.initials: S
authors.lastname: Gianella
authors.affiliation: University of California, San Diego, La Jolla, California, United States of America; Veterans Affairs San Diego Healthcare System, San Diego, California, United States of America.
authors.forename: Davey M
authors.initials: DM
authors.lastname: Smith
authors.affiliation: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, United States of America.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Daar
authors.affiliation: University of Southern California Keck School of Medicine, Los Angeles, California, United States of America.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Dube
authors.affiliation: National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America.
authors.forename: Andrea
authors.initials: A
authors.lastname: Lisco
authors.affiliation: National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, United States of America.
authors.forename: Christophe
authors.initials: C
authors.lastname: Vanpouille
authors.affiliation: National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, United States of America.
authors.forename: Leonid
authors.initials: L
authors.lastname: Margolis
authors.affiliation: University of California, San Diego, La Jolla, California, United States of America.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Haubrich
authors.affiliation: University of California, San Diego, La Jolla, California, United States of America.
authors.forename: Sheldon R
authors.initials: SR
authors.lastname: Morris
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000453:epidemiology; D000328:Adult; D016207:Cytokines / Q000378:metabolism; D003587:Cytomegalovirus / Q000302:isolation & purification / Q000502:physiology*; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000453:epidemiology; D015497:HIV-1; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D012661:Semen / Q000378:metabolism / Q000821:virology*; D013587:Syphilis / Q000175:diagnosis* / Q000453:epidemiology; D014779:Virus Replication
chemical_list: D016207:Cytokines