AEGiS-11IAC: Risk factors associated with genital ulcer disease among HIV-infected women.

11th International AIDS Conference

Vancouver, British Columbia — July 7-12, 1996

Risk factors associated with genital ulcer disease among HIV-infected women.

Int Conf AIDS 1996 Jul 7-12; 11:220 (abstract no. Th.B.115)
Danguilan CR, Tempalski B, LaGuardia KD; The New York Hospital-Cornell Medical Center, New York, NY, USA. Fax: 212-746-8762.

OBJECTIVE: To define clinical, diagnostic, and demographic risk factors associated with genital ulcer disease (GUD) in a cohort of HIV + women.

METHODS: Four hundred and twenty-eight HIV + women were followed from 10/89-4/95 (64 mos). GUD cases were defined as women presenting with vulvar and/or vaginal ulcers, defined as a disruption of the mucosal epithelium (N=46). Controls were defined as women who never presented with ulcers (N=382). Using logistic regression analysis in comparing cases with controls, the following variables were examined: age; race; mode of HIV acquisition; CD4 counts (mm3); histories of N. gonorrhea, C. trachomatis, Herpes simplex virus (HSV), Human papillomavirus (HPV), and syphilis; microbiologic and serologic data for the above STDs; and cervical cytology. Abnormal cytology was determined as High grade squamous intraepithelial lesion (HSIL) and Low grade SIL by the Bethesda System.

RESULTS: Of the 428 subjects, 46 (11%) were ulcer cases. There was no significant difference between cases and controls by age (mean=34); by race (Black=54% vs 42%, White=22% vs 26%, Hispanic=24% vs 31%), by CD4 count (mean=111 vs 89mm3); mode of HIV acquisition (sexual=33% vs 44%, IVDU=35% vs 33%); by history of gonorrhea, chlamydia, or syphilis, or by microbiologic and serologic studies for these infections. Risk markers associated with the development of GUD included history of HSV infection (OR=3.035; p=0.0007); history of HPV infection (OR=2.252; p=0.0177); and abnormal cervical cytology (OR=2.223; p=0.0181). HSIL was three times as prevalent among cases as non-cases (9% vs 3%). Among cases tested, 51% had a positive HSV culture (n=21), and 9% had a reactive VDRL (n=4).

CONCLUSIONS: HIV + women with GUD are more likely to have a history of HPV and HSV infection than non-cases. However, 40% of cases have no clear etiologic agent. The finding of an association between cervical dysplasia and GUD suggests the possibility of a related causal agent. All women presenting with GUD should have cervical cytologic screening in addition to the standard microbiologic assessment. HPV subtyping of ulcer biopsies merits further study.

Keywords: AEGIS, HIV, Papillomavirus, Human, Risk Factors, Cervical Intraepithelial Neoplasia, CD4 Lymphocyte Count, Sexually Transmitted Diseases, Cervix Dysplasia, Vaginal Smears, Cervix Neoplasms, Ulcer, HIV-1, Urogenital Diseases, Peptic Ulcer, Risk, Human, Female, ICA11

960707
ThB115