HIV-1 SEROCONVERSION IN PATIENTS WITH AND WITHOUT GENITAL ULCER DISEASE - A PROSPECTIVE-STUDY

Objective: To determine the relative risk for human immunodeficiency v irus (HIV-1) seroconversion in patients with and without genital ulcer s caused by chancroid, syphilis, and herpes. Design: A prospective coh ort study Setting: An inner-city, sexually transmitted disease clinic. Patients: Patients seronegative for HIV-1 with and without genital ul cers who were followed for a minimum of 3 months. Interventions: Quest ionnaire to obtain data on demographics, sexual behavior, and illicit drug use; testing for HIV-1 at entry and at a minimum of 3 months afte r entry; medical examination for the presence or absence of genital ul cer disease. Results: Overall, 758 heterosexual men with no history of injection drug use completed the study; HIV-1 seroconversion occurred in 10 of 344 (2.9%; 95% CI, 1.4% to 5.3%) men with a genital ulcer an d in 4 of 414 (1%; CI, 0.2% to 2.5%) without a genital ulcer (relative risk, 3.0; P = 0.05). In a multiple logistic regression analysis, tho se men with chancroid and a new sexually transmitted disease during fo llow-up each had about three times the risk for HIV-1 seroconversion ( P less-than-or-equal-to 0.04). Conclusions: In this group of heterosex ual men, chancroid and repeated acquisition of sexually transmitted di seases appeared to facilitate the sexual transmission of HIV-1.