Objective: To determine whether ejaculate exposure through anoreceptive intercourse is associated with rapid CD4 cell loss.
Design: Self-reported behavioral, demographic data and blood samples were gathered longitudinally at ten semiannual visits from individuals participating in the Multicenter AIDS Cohort Study (MACS).
Patients/participants: A group of 937 HIV-seropositive men who were continuously followed for four to ten semiannual visits.
Outcome measures: A loss of 10% or more in CD4 cells between the first two of any three consecutive semiannual visits that was followed by a 10% or greater loss between the second and third visits.
Results: A period of rapid CD4 cell loss over three semiannual visits occurred in 389 of the 937 (42%) HIV-seropositive men studied. Men who reported one or more anoreceptive intercourse partners with whom they were exposed to ejaculate (RAI-E) during the 12 months immediately preceding their visits were more than twice as likely to show this rapid CD4 cell loss compared with men with no such partners.
Conclusions: The association between RAI-E partnerships and rapid CD4 cell loss suggests factors associated with ejaculate exposure (e.g., sexually transmitted diseases) may hasten the clinical progression of HIV disease. It is suggested that infectious diseases, which are known to be associated with ejaculate exposure, may be the causal factor underlying the association between RAI-E partnerships and rapid CD4 cell loss in these men, although the presence of these diseases was not ascertained in these data. HIV-infected individuals should be cautioned against unprotected anoreceptive intercourse.
From the aDivision of Primary Care, School of Nursing, bDepartment of Epidemiology, cDepartment of Biostatistics, dUCLA Center for Clinical AIDS Research and Education (CARE) and eAIDS Institute, University of California at Los Angeles, California, the fDepartment of Epidemiology, Johns Hopkins University, Baltimore, Maryland, gMerck & Co., Inc., West Point, Pennsylvania, the hPittsburgh Cancer Institute, University of Pittsburgh, Pittsburgh, Pennsylvania and the iDepartment of Preventive Medicine, Northwestern University Medical School, Chicago, Illinois, USA.
Sponsorship: This work was supported by the Interdisciplinary Training in HIV/AIDS Epidemiology under NIAID Grant R-32-AI07481 and by the Center for HIV Identification, Prevention and Treatment Services (CHIPTS) Grant P-30-MH58107 (NIMH).
Requests for reprints to: D.J. Wiley, School of Nursing, Department of Primary Care, University of California at Los Angeles, 700 Tiverton Avenue, Los Angeles, California, 90095-6919, USA.
Received: 23 December 1999; accepted: 14 January 2000.