Abstract

Increased risk of genital ulcer disease in women during the first month after initiating antiretroviral therapy

Graham, S. M. Masese, L. Gitau, R. Mwakangalu, D. Jaoko, W. Ndinya-Achola, J. Mandaliya, K. Peshu, N. Baeten, J. M. McClelland, R. S.
J Acquir Immune Defic Syndr. 2009; 52600-3

Permanent descriptor

https://doi.org/10.1097/QAI.0b013e3181b065cf

INTRODUCTION: Genital ulcer disease (GUD) is common in HIV-1-infected women, and a small number of studies have suggested increased GUD risk after antiretroviral therapy (ART) initiation. To better define this risk, we monitored 134 women at ART initiation and monthly thereafter. METHODS: Women were evaluated monthly for genital ulcers. Syphilis serology was tested quarterly, and chancroid culture was performed on ulcers that were felt to be clinically consistent with a diagnosis of chancroid. A logistic model with generalized estimating equations was used to analyze predictors of GUD from baseline until 6 months after ART initiation. RESULTS: During the study period, GUD occurred in 54 women (40.3%) at 85 visits (10.0%). GUD prevalence was 9.7% at baseline, increased to 16.7% at month 1 [adjusted odds ratio (aOR) 1.9 (1.0-3.6), P = 0.04], then decreased to 6.4% by month 6. History of GUD [aOR 3.8 (1.9-7.7), P < 0.001) and CD4 count <100 [aOR 1.8 (1.0-3.4), P = 0.06] were associated with increased risk of GUD after ART initiation. DISCUSSION: Women experience increased risk of GUD in the first month after ART initiation, particularly if they have low CD4 counts or a history of GUD.