Acute HIV Infections among Men with Genital Ulcer Disease in South Africa

Abstract

We investigated acute human immunodeficiency virus (HIV) infection among men enrolled in a genital ulcer treatment trial in South Africa. HIV-negative participants were tested at baseline by HIV RNA polymerase chain reaction and followed up after 1 month to measure HIV seroconversion. There were 228 HIV-negative men at baseline; 10 were positive for HIV RNA, and 8 seroconverted to HIV at day 28. The prevalence of acute HIV among HIV-negative men at baseline was 18 (7.9%) of 228 men (95% confidence interval [CI], 4.4-11.4) and 18 (2.9%) of 615 men (95% CI, 1.6-4.3) in the overall study population. These data highlight the importance of genital ulcer patients in HIV transmission. Trial Registration. ClinicalTrials.gov identifier: NCT00164424 .

Trends in the relative prevalence of genital ulcer disease pathogens and association with HIV infection in Johannesburg, South Africa, 2007–2015

“…Among South African men enrolled in a clinical trial of acyclovir treatment for genital ulcer disease, acute HIV infection was associated with an almost eight times greater likelihood of having genital ulcers of unknown aetiology compared with herpetic ulcers. [ 2 ] In the same trial, over 45% of HIV-infected men were found to have detectable HIV-1 RNA in ulcers, and those with ulcers of unknown aetiology were more likely to have HIV-1 lesional shedding than those with HSV-2 ulceration. [ 3 ] Other possible causes include non-infectious conditions such as genital trauma and Behçet’s syndrome [ 25 ] or, rarely, malignancies such as squamous cell carcinoma.…”

Detection and management of acute HIV infections in patients with sexually transmitted infections: a window of opportunity for HIV prevention within South Africa?

“…2 In terms of diagnostic yield, STI clinics have been shown to be feasible sites to screen patients for acute HIV infection in North Carolina (USA), Malawi, and South Africa. 6,8,33 With the use of a 50:10:1 three-stage hierarchical pooling strategy, a retrospective cross-sectional study of consecutive patients from STI and dermatology clinics in Lilongwe, Malawi, demonstrated that 4.5% of HIV-seronegative STI patients were HIV RNA positive, in comparison with 0.2% of HIV-seronegative dermatology patients. 6 Documented risk factors were inguinal lymphadenopathy, genital ulcerations, and an age range of 24-26 years for the STI clinic patients.…”

“…Within South Africa, acute HIV infections have been detected at a higher prevalence in STI patients, compared to patients admitted to hospital, or women attending antenatal clinics (Table I). 8,[48][49][50][51] Stevens et al reported that 0.99% of a combination of HIV-seronegative STI patients and HCT clients, had HIV RNA detected in their sera in Gauteng province. 51 Kharsany et al reported a HIV RNA detection rate of 1.2% among HIV-seronegative female STI patients in KwaZulu-Natal province.…”

“…6 Furthermore, it has also been suggested that, within sub-Saharan Africa, the rate of HIV transmission from a man with acute HIV infection, to an uninfected female partner, could exceed 50% in partnerships in which either partner has an STI. [6][7][8] Therefore, increased efforts to diagnose acute HIV infection in STI patients are likely to be of public health benefit. Firstly, this article will review the early immunological events, clinical features and laboratory diagnosis of acute HIV infection.…”

“…Prevalence of acute HIV infections in different public sector clinical settings within South Africa PHCs: primary healthcare clinics, RNA: ribonucleic acid, VCT: voluntary counselling and testing higher detection rate of acute HIV infections (5.4%) among HIV-seronegative male patients with genital ulcers in Gauteng province 8. Using multivariate analysis, the authors reported that the diagnosis of acute HIV infection was associated with the absence of a stable partner, genital lymphadenopathy, and the presence of an ulcer of unknown aetiology 8. …”