Another HIV Study
Find a Conversation
|Mon, 07-20-2009 - 8:38am|
AIDS. 2009 Jul 3.
Foreskin inflammation is associated with HIV and herpes simplex virus type-2 infections in Rakai, Uganda.
Johnson KE, Sherman ME, Ssempiija V, Tobian AA, Zenilman JM, Duggan MA, Kigozi G, Serwadda D, Wawer MJ, Quinn TC, Rabkin CS, Gray RH.
aDepartment of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, USA bNational Cancer Institute, Rockville, Maryland, USA cRakai Health Sciences Program, Kalisizo, Uganda dDepartment of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, USA eDepartment of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA fDepartment of Pathology and Laboratory Medicine, University of Calgary, Alberta, Canada gSchool of Public Health, Makerere University, Kampala, Uganda hDivision of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA. * Additional authors listed in acknowledgements section.
DESIGN:: We assessed foreskin inflammation associated with HIV and herpes simplex virus type 2 (HSV-2) in circumcised men.
METHODS:: Foreskin tissues were assessed in 97 HIV-infected and 135 HIV-uninfected men enrolled in randomized trials of circumcision in Rakai, Uganda. Inflammation was quantified using an ordinal score evaluating extent, intensity, and cellular composition of infiltrates in the epithelium and stroma. Prevalence rate ratios of inflammation were estimated by multivariate Poisson regression.
RESULTS:: Foreskin inflammation was primarily focal. Epithelial inflammation was present in 4.2% of men with neither HIV nor HSV-2 infection; 7.8% of men with only HSV-2; 19.0% with HIV alone (P = 0.04); and 31.6% in HIV/HSV-2 coinfected men . Stromal inflammation was present in 14.1% of HIV/HSV-2 uninfected men, compared with 29.7% in men with HSV-2 alone (P = 0.03), 33.3% in men with HIV alone (P = 0.04), and 61.0% in men with HIV/HSV-2 coinfection (PRR 4.3, 95% CI 2.3-7.9, P < 0.001). In HIV-infected men, epithelial inflammation was associated with higher HIV viral load. Epithelial inflammation was more frequent among men reporting recent genital ulceration. Both epithelial and stromal inflammation were more common among men with smegma on physical examination.
CONCLUSION:: Foreskin inflammation is increased with HIV and HSV-2 infections, higher HIV viral load and presence of smegma. Foreskin inflammation may have implications for HIV transmission and acquisition in uncircumcised men.