HUMAN-IMMUNODEFICIENCY-VIRUS DNA IN URETHRAL SECRETIONS IN MEN - ASSOCIATION WITH GONOCOCCAL URETHRITIS AND CD4 CELL DEPLETION

To evaluate the prevalence and correlates of human immunodeficiency vi rus (HIV)-infected cells in urethral secretions, samples were collecte d from 106 HIV-seropositive men with and without urethritis. HIV DNA w as detected by polymerase chain reaction in 27% of 184 urethral specim ens and was associated with CD4 cell depletion (P for trend, .03) and with urethritis (odds ratio [OR], 2.4; 95% confidence interval [CI], 1 .2-4.6) or gonorrhea (OR, 2.9; 95% CI, 1.5-5.8). Two multivariate mode ls were constructed that included age, CD4 cell count <200/mm(3), and either urethritis or gonococcal infection. Detection of HIV-infected c ells in urethral secretions was independently associated with <200 CD4 cells/mm(3) (OR, 2.2; 95% CI, 0.9-5.2; P = .05) and urethritis (OR, 2 .7; 95% CI, 1.3-5.3; P = .003) in the first model and with gonococcal infection (OR, 3.2; 95% CI, 1.6-6.4; P < .001) in the second model. Su ccessful treatment of gonococcal urethritis was associated with a 2-fo ld reduction in urethral HIV DNA (44% vs, 21%; P = .02). Thus, treatme nt of gonococcal urethritis may be an effective strategy for reducing HIV transmission.