Kaul R, Kimani J, Nagelkerke N J, Plummer F A, Bwayo J J, Brunham R C, Ngugi E N, Ronald A
Department of Medical Microbiology, University of Nairobi, Kenya.
Sex Transm Dis. 1997 Aug;24(7):387-92. doi: 10.1097/00007435-199708000-00001.
Genital ulcer disease (GUD) is a major risk factor for human immunodeficiency virus (HIV) transmission. Cross-sectional studies have suggested that HIV infection may itself predispose to genital ulceration (GU).
To prospectively study the effects of HIV type 1 (HIV-1) infection and behavioral variables on GU incidence.
A cohort of 302 Kenyan female sex-workers was established in April 1991. Women were scheduled for assessment every 2 weeks, and bloods were collected every 6 months for HIV serology, rapid plasma reagin (RPR) and CD4 counts. Logistic regression was used to study risk factors for incident genital ulcers.
189 women (62.5%) had at least one incident ulcer over 24.3 +/- 15.3 months. GU incidence was higher in seropositive than initially seronegative women (82% vs. 48%; odds ratio [OR]) = 4.33; P < 0.01). Only HIV-1 seropositivity (OR = 3.42), a CD4 count < 200/ml (OR = 1.94), and oral contraceptive use (OR = 1.35) were associated (P < 0.05) with GU incidence in regression analysis. For those ulcers where an etiology was actively sought, Hemophilus ducreyi was confirmed in 54 (19%) of cases, and syphilis in 30 (29%).
GU incidence in Kenyan sex workers is independently affected by HIV-1 serostatus, degree of immunosuppression, and oral contraceptive use.
生殖器溃疡疾病（GUD）是人类免疫缺陷病毒（HIV）传播的主要危险因素。横断面研究表明，HIV感染本身可能易导致生殖器溃疡（GU）。
前瞻性研究1型HIV（HIV-1）感染及行为变量对GU发病率的影响。
1991年4月建立了一个由302名肯尼亚女性性工作者组成的队列。女性每2周接受一次评估，每6个月采集血液进行HIV血清学、快速血浆反应素（RPR）及CD4计数检测。采用逻辑回归研究新发生殖器溃疡的危险因素。
在24.3±15.3个月期间，189名女性（62.5%）至少发生过一次溃疡。血清阳性女性的GU发病率高于最初血清阴性的女性（82%对48%；优势比[OR]=4.33；P<0.01）。在回归分析中，仅HIV-1血清阳性（OR=3.42）、CD4计数<200/ml（OR=1.94）及口服避孕药的使用（OR=1.35）与GU发病率相关（P<0.05）。对于积极寻找病因的溃疡，54例（19%）确诊为杜克雷嗜血杆菌感染，30例（29%）为梅毒。
肯尼亚性工作者的GU发病率独立受到HIV-1血清状态、免疫抑制程度及口服避孕药使用的影响。
