RESUMO
BACKGROUND: Genital ulcer diseases (GUDs) are a common syndrome associated with sexually transmitted infections. Genital ulcer diseases increase the risk of HIV transmission, necessitating appropriate diagnosis and treatment. We provide an updated GUD etiology assessment in Malawi to guide diagnostic development and treatment algorithms. METHODS: We enrolled patients 18 years or older presenting with GUD at a sexually transmitted infection clinic in Lilongwe, Malawi, between May and October 2021. We purposively sampled by HIV status. Swabs of ulcers were tested for Treponema pallidum, herpes simplex virus (HSV)-1 and HSV-2, Haemophilus ducreyi, and Chlamydia trachomatis using polymerase chain reaction. Blood was collected for syphilis and HSV-2 serologies and acute HIV testing. Participants were treated per Malawi guidelines. Ulcer resolution (size reduced by >50%) was evaluated 14 days later. RESULTS: Fifty participants enrolled (30 without HIV, 2 with acute HIV infection, 18 with HIV seropositivity; 32 men, 18 women). Forty-six (92%) had an etiology identified. Syphilis was more common among those without HIV (22 of 30 [73%]) than participants with HIV (PWH; 8 of 20 [40%]; P = 0.04). Herpes simplex virus was more common among PWH (11 of 20 [55%]) than participants without (2 of 30 [7%]; P = 0.0002). One-fifth (9 of 50 [18%]) had H. ducreyi. Among those who returned for follow-up (n = 45), 9 (20%) had unresolved ulcers; persistent GUD was slightly more common in PWH (6 of 19 [32%]) than participants without (3 of 26 [12%]; P = 0.14). CONCLUSIONS: We observed a dramatic increase in syphilis ulcer proportion in a population whose GUDs were previously HSV predominant. Observed differences in etiology and resolution by HIV status could play an important role in the ongoing transmission and treatment evaluation of GUD.
Assuntos
Doenças dos Genitais Masculinos , Infecções por HIV , Herpes Genital , Herpesvirus Humano 1 , Infecções Sexualmente Transmissíveis , Sífilis , Masculino , Humanos , Feminino , Úlcera/epidemiologia , Úlcera/etiologia , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Sífilis/complicações , Sífilis/epidemiologia , Sífilis/diagnóstico , Malaui/epidemiologia , Infecções Sexualmente Transmissíveis/epidemiologia , Herpesvirus Humano 2 , Genitália , Herpes Genital/complicações , Herpes Genital/epidemiologia , Doenças dos Genitais Masculinos/etiologiaRESUMO
BACKGROUND: Prior to the widespread availability of antiretroviral therapy (ART), men living with human immunodeficiency virus (HIV) with urethritis had increased concentrations of HIV in semen. This study aims to better evaluate HIV shedding in men with urethritis receiving ART, and its implications for the cure of HIV. METHODS: Men living with HIV with urethritis taking ARTâ ≥12 weeks were enrolled at a sexually transmitted infections clinic in Lilongwe, Malawi. Study follow-up included visits at 1, 2, 4, 8, 12, 24, 36, and 48 weeks after urethritis diagnosis and treatment. Matched blood and semen samples were collected at all visits, and all additional episodes of urethritis were followed with extra visits 1, 2, and 4 weeks after treatment. RESULTS: There were 111 men enrolled in the study between January 2017-March 2019, and 77 (69%) were suppressed in the blood (<400 copies/mL). Among the 77 men, 87 episodes of urethritis were evaluated during follow-up. Of the 87 episodes, 15 episodes (17%) had instances of seminal viral sheddingâ ≥400 copies/mL despite viral suppression in the blood. During nonurethritis follow-up, ≤6% of men at each visit had a viral loadâ ≥400 copies/mL in the semen while maintaining viral suppression in the blood. CONCLUSIONS: An HIV cure requires the elimination of HIV from every body compartment, but available ART does not currently accomplish this. Our study highlights the male genital tract as a local source of HIV that can be reversibly activated. A better understanding of this phenomenon is important to advance the HIV cure field.
Assuntos
Infecções por HIV , HIV-1 , Uretrite , Infecções por HIV/tratamento farmacológico , HIV-1/genética , Humanos , Masculino , RNA Viral , Sêmen , Uretrite/tratamento farmacológico , Carga Viral , Eliminação de Partículas ViraisRESUMO
OBJECTIVES: To examine the time required to suppress HIV in the genital tract with antiretroviral therapy (ART) in men with urethritis. DESIGN: An observational cohort study. METHODS: Men with HIV and urethritis not on ART were enrolled at an STI clinic in Malawi and offered to initiate ART. Blood and semen samples were collected pretreatment and at 1, 2, 4, 8, 12 and 24âweeks posturethritis treatment. Median viral loads (VLs) were calculated by ART initiation groups: 'within 1 week', 'between 1 and 4 weeks' and 'no ART before 4 weeks', based on the men's choice about whether or not to initiate ART. The presence of ART at each visit was confirmed by bioanalytical methods. FINDINGS: Between January 2017 and November 2018, 74 men presented with urethritis and HIV and were confirmed ART naive. The median age was 32âyears. Forty-one (55% of men) initiated ART within 1âweek; 12 (16%) between 1 and 4âweeks; and 21 (28%) did not initiate ART by week 4. Within the 1âweek group, median VL was suppressed within 4âweeks in both semen and blood. Among the 1-4âweeks group, VL was suppressed within 4âweeks in semen and 5âweeks in blood. Among the no ART before 4âweeks group, VL in semen declined within the first 4âweeks but remained unsuppressed through week 24, and there was no significant decline in blood HIV. CONCLUSION: Treatment of urethritis and prompt initiation of ART with counseling for safer sex for at least one month is a critical measure to reduce transmission of HIV.