INCIDENCE AND PREDICTORS OF HUMAN-IMMUNODEFICIENCY-VIRUS TYPE-1 SEROCONVERSION IN PATIENTS ATTENDING SEXUALLY-TRANSMITTED DISEASE CLINICS IN INDIA

The first estimates of the seroincidence of human immunodeficiency vir us type 1 (HIV-1) and of the risk factors for seroconversion in a coho rt of high-risk patients attending sexually transmitted disease (STD) clinics in India are reported. Between 1993 and 1995, 851 HIV-1-serone gative persons were evaluated prospectively every 3 months for HIV inf ection and biologic and behavioral characteristics. The overall incide nce of HIV-1 was 10.2/100 person-years (95% confidence interval, 7.9-1 3.1). The incidence among commercial sex workers (CSWs) was 26.1/100 p erson-years, compared with 8.4 among non-CSWs. Recurrent genital ulcer disease and urethritis or cervicitis during the follow-up period were independently associated with a 7- (P < .001) and 3-fold (P = .06) in creased risk of HIV-1 seroconversion, respectively. Because of the ass ociation of recurrent ulcerative and nonulcerative STDs with HIV-1 ser oconversion in this setting, behavioral and biologic measures directed at the prevention and control of STDs would be expected to greatly re duce the transmission of HIV-1 infection in similar high-risk groups.