ASYMPTOMATIC GENITOURINARY CHLAMYDIA-TRACHOMATIS INFECTION IN WOMEN SEROPOSITIVE FOR HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION

Objective: To evaluate the prevalence of asymptomatic Chlamydia tracho matis genitourinary infection in women with human immunodeficiency vir us (HIV) infection. Methods: The prevalence of asymptomatic chlamydial genitourinary infection in HIV-seropositive women was compared with b oth HIV-seronegative controls and women with unknown HIV status. Chlam ydia trachomatis was isolated in cell culture from endocervical and ur ethral specimens. Results: The prevalence of genitourinary C trachomat is infection among HIV-seropositive women was 18.3% (21 of 115), a rat e significantly higher than in both HIV-negative women (11 of 136; P = .016) and controls with unknown HIV status (18 of 326; P = .0001). Cr ude odds ratios for endocervical and urethral chlamydial infection in HIV-seropositive women compared to HIV-seronegative controls were 2.6 (95% confidence interval [CI] 1.13-6.08) and 3.3 (95% CI 1.15-9.67), r espectively. After adjustment for variables related to sexual habits, there was no difference in the risk of cervical C trachomatis infectio n between HIV-seropositive cases and HIV-seronegative controls (Mantel -Haenszel odds ratio 1.04, 95% CI 0.93-1.14; P =.41). Finally, in HIV- seropositive patients, both the severity of immuno-suppression evaluat ed by CD4+, CD8+, and total lymphocyte counts and the detection of p24 HIV-related antigen did not correlate with the presence of chlamydial infection. Conclusions: Women infected with HIV are at high risk for asymptomatic genitourinary chlamydial colonization. To prevent a possi ble ''epidemic'' of pelvic inflammatory disease, appropriate screening programs and therapeutic strategies should be planned.