ArticlesReduction of concentration of HIV-1 in semen after treatment of urethritis: implications for prevention of sexual transmission of HIV-1
Introduction
In areas most severely affected by the HIV-1 pandemic, viral transmission occurs almost exclusively through heterosexual contact.1 Regional heterogeneity in HIV-1 transmission rates is associated with rapid expansion of epidemics in parts of the developing world and may be explained by behavioural and host-related or virus-related biological factors.1, 2 The development of practical and affordable strategies to prevent heterosexual HIV-1 transmission requires a more detailed understanding of reversible biological factors that influence viral transmission.3
Epidemiological studies provide strong evidence that ulcerative and non-ulcerative sexually transmitted diseases (STDs) significantly increase the risk of acquiring HIV-1.4, 5 Consistent with this evidence, improved treatment of STDs in Tanzania was associated with a 42% reduction in the incidence of HIV-1 infections.6 Although the biological mechanism remains unclear, inflammation associated with STDs enriches mucosal tissues with activated cells that are receptive to HIV-1 infection, and could increase physical access to such cells.7 Equally important, STDs and reproductive-tract inflammation may increase levels of HIV-1 shedding in genital secretions and lead to increased infectiousness and a greater possibility of HIV-1 transmission.8, 9, 10, 11
We measured concentrations of HIV-1 RNA in cell-free seminal plasma from HIV-1-seropositive men with urethritis before and after antibiotic therapy. The results were compared with those seen in HIV-1-seropositive men who had no clinical evidence of urethritis.
Section snippets
Methods
We did this study at the Kamuzu Central Hospital in Lilongwe, Malawi, between January and March, 1996. The protocol was approved by the University of North Carolina Committee on the Protection of Human Rights and the Malawi Health Sciences Research Committee. All study participants gave informed consent and were offered a small payment for their participation. The study design was a prospective, sequential comparison of two cohorts: HIV-1-infected men with urethritis, selected from the STD
Results
206 men with urethritis (the STD group) and 127 controls were enrolled (table). 113 (55%) men from the STD-clinic group and 60 (48%) controls from the dermatology clinics were HIV-1 seropositive, which is consistent with our previous findings in Malawi.12, 13 86 HIV-1-seropositive men in the STD group and 49 seropositive controls with no urethritis provided baseline semen samples. Of these, 81 and 74 STD-group patients, respectively, provided semen 1 week (median 7 days [range 5–8]) and 2 weeks
Discussion
The efficiency of transmission of HIV-1 most likely reflects the phenotype of the virus,16 the size of the inoculum,17, 18, 19 and host genetic and immune factors.20, 21, 22 The concentration of HIV-1 RNA in blood plasma correlates with the likelihood of transmission by blood transfusion, as well as by vertical and heterosexual routes.17, 18, 19 Sexual transmission of HIV has even greater variability in efficiency than other routes,23 and this variability has been ascribed to cofactors that
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