Association of CD4 Cell Depletion and Elevated Blood and Seminal Plasma Human Immunodeficiency Virus Type 1 (HIV-1) RNA Concentrations with Genital Ulcer Disease in HIV-1-Infected Men in Malawi

CD4 cell counts and blood plasma and seminal plasma HIV-1 concentrations were compared in HIV-1 RNA-seropositive men with urethritis and with or without genital ulcer disease (GUD). GUD was associated with lower CD4 cell counts (median 258/mcl vs. 348/mcl) and increased blood plasma HIV-1 RNA (median 240 x 10 vs. 79.4 x 10 copies/ml). Men with nongonococcal urethritis and GUD shed significantly greater quantities of HIV-1 in semen (median 195 x 10 vs. 4.0 x 10 copies/ml) than men with nongonococcal urethritis without GUD. These levels decreased approximately 4-fold following antibiotic therapy. The results indicate an association between GUD and increased blood HIV-1 RNA levels. Increased HIV-1 in semen was demonstrated in some men with GUD; such an increase could lead to increased transmission thus complicating interpretation of the role of the genital ulcer itself in the infectiousness of HIV. Reasons for increased HIV RNA in semen in men with GUD remain to be determined. (authors)