ASSOCIATION OF CD4 CELL DEPLETION AND ELEVATED BLOOD AND SEMINAL PLASMA HUMAN-IMMUNODEFICIENCY-VIRUS TYPE-1 (HIV-1) RNA CONCENTRATIONS WITHGENITAL ULCER DISEASE IN HIV-1-INFECTED MEN IN MALAWI

CD4 cell counts and blood plasma and seminal plasma human immunodefici ency virus type 1 (HIV-1) concentrations were compared in HIV-1 RNA-se ropositive men with urethritis and with or without genital ulcer disea se (GUD), GUD was associated with lower CD4 cell counts (median, 258 v s, 348/mu L) and increased blood plasma HIV-1 RNA (median, 240 x 10(3) vs, 79.4 x 10(3) copies/mK). Men with nongonococcal urethritis and GU D shed significantly greater quantities of HIV-1 in semen (median, 195 x 10(3) vs. 4.0 x 10(3) copies/mL) than men with nongonococcal urethr itis without GUD, These levels decreased similar to 4-fold following a ntibiotic therapy, The results indicate an association between GUD and increased blood HIV-1 RNA levels, Increased HIV-1 in semen was demons trated in some men with GUD; such an increase could lead to increased transmission, thus complicating interpretation of the role of the geni tal ulcer itself in the infectiousness of HIV, Reasons for increased H IV RNA in semen in men with GUD remain to be determined.