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HIV-1 Seroconversion in Patients with and without Genital Ulcer Disease: A Prospective Study

Edward E. Telzak, MD; Mary Ann Chiasson, DrPH; Pamela J. Bevier, MPH; Rand L. Stoneburner, MD; Kenneth G. Castro, MD; and Harold W. Jaffe, MD
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From the New York City Department of Health, New York, New York; the Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, New York; the Centers for Disease Control and Prevention, Atlanta, Georgia. Requests for Reprints: Edward E. Telzak, MD, Division of Infectious Diseases, Bronx Lebanon Hospital Center, Albert Einstein College of Medicine, 1650 Grand Concourse, Bronx, NY 10457. Acknowledgments: The authors thank Steve Blum, PhD, from the New York City Department of Health for his epidemiologic guidance and comments throughout the course of the study; Jesus Rivera, Deborah Hildebrandt, William E. Ewing, Richard Heffernan, Eneida Garafalo, and Richard Munoz for their hard work and practical insights; and Drs. Debra Hanson, John Karon, and Meade Morgan from the Division of HIV/AIDS, National Center for Infectious Diseases, Centers for Disease Control and Prevention, for their statistical support and comments. Grant Support: In part by Centers for Disease Control and Prevention #U64/CCU203312.

Copyright 2004 by the American College of Physicians

Ann Intern Med. 1993;119(12):1181-1186. doi:10.7326/0003-4819-119-12-199312150-00005
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Objective: To determine the relative risk for human immunodeficiency virus (HIV-1) seroconversion in patients with and without genital ulcers caused by chancroid, syphilis, and herpes.

Design: A prospective cohort study.

Setting: An inner-city, sexually transmitted disease clinic.

Patients: Patients seronegative for HIV-1 with and without genital ulcers who were followed for a minimum of 3 months.

Interventions: Questionnaire to obtain data on demographics, sexual behavior, and illicit drug use; testing for HIV-1 at entry and at a minimum of 3 months after entry; medical examination for the presence or absence of genital ulcer 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 and 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, those men with chancroid and a new sexually transmitted disease during follow-up each had about three times the risk for HIV-1 seroconversion (P 0.04).

Conclusions: In this group of heterosexual men, chancroid and repeated acquisition of sexually transmitted diseases appeared to facilitate the sexual transmission of HIV-1.


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Figure 1.
The sexual risk index for heterosexual men compared by diagnosis (with or without chancroid) and HIV-1 seroconversion status.

The sexual risk index (SRI) score equals the summary measure of the number of sexual partners multiplied times the HIV prevalence, using a scale of 0 to 100.

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