Contribution of HIV-1 infection to acquisition of sexually transmitted disease: a 10-year prospective study

J Infect Dis. 2005 Feb 1;191(3):333-8. doi: 10.1086/427262. Epub 2004 Dec 22.


Background: Sexually transmitted diseases (STDs) enhance human immunodeficiency virus (HIV)-1 susceptibility, but few studies have examined the reciprocal effect of HIV-1 on STD acquisition.

Methods: Data from a prospective cohort study conducted among female sex workers in Mombasa, Kenya between 1993 and 2003 were used to determine the effect of HIV-1 infection on STD susceptibility. The cohort included 1215 HIV-1-seronegative women who underwent monthly HIV-1 and STD screening, of whom 238 experienced seroconversion to HIV-1 during follow-up. Andersen-Gill proportional-hazards models were used to compare the incidence rates for genital-tract infections (syphilis, genital ulcer disease [GUD], Neisseria gonorrhoeae infection, Chlamydia trachomatis infection, Trichomonas vaginalis infection, vulvovaginal candidiasis, and bacterial vaginosis) in HIV-1-seropositive versus HIV-1-seronegative women, after controlling for sexual behavior and other potential confounding factors.

Results: HIV-1 infection was associated with a significantly higher incidence of GUD (hazard ratio [HR], 2.8; 95% confidence interval [CI], 2.0-3.9), gonorrhea (HR, 1.6; 95% CI, 1.1-2.2), and vulvovaginal candidiasis (HR, 1.5; 95% CI, 1.3-1.8). The risks of GUD and vulvovaginal candidiasis increased with progressive levels of immunosuppression.

Conclusions: The increased incidence of genital-tract infections among HIV-1-seropositive women could promote the spread of both HIV-1 and other STDs, particularly in areas where these conditions are highly prevalent.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Cohort Studies
  • Female
  • Genital Diseases, Female / epidemiology
  • Genital Diseases, Female / etiology
  • HIV Infections / complications*
  • HIV Infections / epidemiology
  • HIV Infections / transmission
  • HIV-1 / physiology
  • Humans
  • Incidence
  • Kenya / epidemiology
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Factors
  • Sex Work*
  • Sexually Transmitted Diseases / epidemiology*
  • Sexually Transmitted Diseases / etiology
  • Sexually Transmitted Diseases / transmission*