RISK-FACTORS FOR GENITAL ULCERATIONS IN KENYAN SEX WORKERS - THE ROLEOF HUMAN-IMMUNODEFICIENCY-VIRUS TYPE-I INFECTION

Background and Objectives: Genital ulcer disease (GUD) is a major risk factor for human immunodeficiency virus (HIV) transmission. Cross-sec tional studies have suggested that HIV infection may itself predispose to genital ulceration (GU). Goal: To prospectively study the effects of HIV type 1 (HIV-1) infection and behavioral variables on GU inciden ce. Methods: A cohort of 302 Kenyan female sex-workers was established in April 1991. Women were scheduled for assessment every 2 weeks, and bloods were collected every 6 months for HIV serology, rapid plasma r eagin (RPR) and CD4 counts. Logistic regression was used to study risk factors for incident genital ulcers. Results: 189 women (62.5%) had a t least one incident ulcer over 24.3 +/- 15.3 months. GU incidence was higher in seropositive than initially seronegative women (82% vs, 48% ; odds ratio [OR]) = 433; P < 0.01). Only HIV-1 seropositivity (OR = 3 .42), a CD4 count < 200/ml (OR = 1.94), and oral contraceptive use (OR = 1.35) were associated (P < 0.05) with GU incidence in regression an alysis. For those ulcers where an etiology was actively sought, Hemoph ilus ducreyi was confirmed in 54 (19%) of cases, and syphilis in 30 (2 9%). Conclusion: GU incidence in Kenyan sex workers is independently a ffected by HIV-1 serostatus, degree of immunosuppression, and oral con traceptive use.