HIV-1 Shedding and Chlamydial Urethritis

To the Editor. —Drs Schmid and Fontanarosa1thoroughly discussed the causes and management of nongonococcal urethritis. However, they did not emphasize the link between treatment of sexually transmitted diseases and prevention of human immunodeficiency virus (HIV).2We collected ejaculate from a 32-year-old white man with HIV-1 disease and a CD4 cell count of 0.11×109/L who was taking no antiretroviral therapy. The patient had chlamydial urethritis at the time the sample was obtained, with dysuria but without discharge. We performed quantitative HIV-1 culture on his seminal cell fraction, using a modification of the AIDS Clinical Trials Group quantitative cell culture protocol. We had previously performed 32 quantitative cultures for HIV-1 using seminal cells from 25 HIV-1—infected individuals; the range of excretion was <3.0 to 2523.3 infectious units per ejaculate. Our patient excreted 6729 infectious units of HIV-1 in his ejaculate obtained at the time of chlamydial infection