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The associations between cervicovaginal HIV shedding, sexually transmitted diseases and immunosuppression in female sex workers in Abidjan, Côte d'Ivoire

Ghys, Peter D.1,2,5; Fransen, Katrien2; Diallo, Mamadou O.1; Ettiègne-Traoré, Virginie1; Coulibaly, Issa-Malick3; Yeboué, Kouadio M.1; Kalish, Marcia L.4; Maurice, Chantal1; Whitaker, J Patrick1,4; Greenberg, Alan E.1,4; Laga, Marie2

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Objective: To measure the frequency and associated factors of cervicovaginal HIV shedding and to determine the impact of sexually transmitted disease (STD) treatment on HIV shedding.

Design: Cross-sectional study with 1-week follow-up.

Setting: Confidential clinic for female sex workers in Abidjan, Côte d'Ivoire.

Participants: A total of 1201 female sex workers.

Interventions: STD treatment based on clinical signs.

Main outcome measures: HIV serostatus; cervicovaginal HIV shedding at enrolment and at 1-week follow-up; STD status at enrolment and at 1-week follow-up.

Results: Cervicovaginal shedding of HIV-1 in HIV-1-seropositive women was more frequent (96 out of 404, 24%) than shedding of HIV-2 in HIV-2-seropositive women [one out of 21, 5%; odds ratio (OR), 6.2; 95% confidence interval (CI), 1.0–261]. Among 609 HIV-1-seropositive or dually seroreactive women, HIV-1 shedding was significantly more frequent in immunosuppressed women [adjusted OR (AOR), 6.3; 95% CI, 3.4–11.9; and AOR, 2.9; 95% CI, 1.6–5.0 for CD4 < 14% and CD4 14–28%, respectively, versus CD4 > 28%], and in women with Neisseria gonorrhoeae (AOR, 1.9; 95% CI, 1.2–3.0), those with Chlamydia trachomatis (AOR, 2.5; 95% CI, 1.1–5.8), and with a cervical or vaginal ulcer (AOR, 3.9; 95% CI, 2.1–7.4). HIV-1 shedding decreased from 42 to 21% (P < 0.005) in women whose STD were cured.

Conclusions: These data help to explain the difference in transmissibility between HIV-1 and HIV-2 and the increased infectiousness of HIV in the presence of immunosuppression and STD. In addition, they lend biological plausibility to arguments for making STD control an integral part of HIV prevention strategies in Africa.

1Projet RETRO-CI, Abidjan, Côte d'Ivoire

2Institute of Tropical Medicine, Antwerp, Belgium

3Programme National de Lutte contre le SIDA, les MST et la Tuberculose, Abidjan, Côte d'Ivoire

4Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

5Requests for reprints to: Dr Peter D. Ghys, Projet RETRO-CI, 01 BP 1712, Abidjan 01, Côte d'Ivoire.

Sponsorship: The study was supported in part by grants from the European Community Programme on Science and Technology for Development, Brussels, and Nationaal Fonds voor Wetenschappelijk Onderzoek, Brussels; P.D.G. is a scholar of the American Foundation for AIDS Research.

Note: The use of trade names and commercial sources is for identification only and does not imply endorsement by the Public Health Service or the US Department of Health and Human Services.

Date of receipt: 1 May 1997; revised: 25 June 1997; accepted: 26 June 1997.

© Lippincott-Raven Publishers.