Foreskin inflammation is associated with HIV and herpes simplex virus type-2 infections in Rakai, Uganda

Kristine E. Johnson, Mark E. Sherman, Victor Ssempiija, Aaron A.R. Tobian, Jonathan M. Zenilman, Maire A. Duggan, Godfrey Kigozi, David Serwadda, Maria J. Wawer, Thomas C. Quinn, Charles S. Rabkin, Ronald H. Gray

Research output: Contribution to journalArticle

35 Scopus citations

Abstract

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 [prevalence rate ratio (PRR) 7.5, 95% confidence interval (CI) 2.3-23.8, P < 0.001]. 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.

Original languageEnglish (US)
Pages (from-to)1807-1815
Number of pages9
JournalAIDS
Volume23
Issue number14
DOIs
StatePublished - Sep 1 2009

Keywords

  • Circumcision
  • Foreskin
  • HIV
  • Herpes simplex virus type 2
  • Inflammation
  • Uganda

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

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  • Cite this

    Johnson, K. E., Sherman, M. E., Ssempiija, V., Tobian, A. A. R., Zenilman, J. M., Duggan, M. A., Kigozi, G., Serwadda, D., Wawer, M. J., Quinn, T. C., Rabkin, C. S., & Gray, R. H. (2009). Foreskin inflammation is associated with HIV and herpes simplex virus type-2 infections in Rakai, Uganda. AIDS, 23(14), 1807-1815. https://doi.org/10.1097/QAD.0b013e32832efdf1