Genital shedding of human immunodeficiency virus type 1 DNA during pregnancy: association with immunosuppression, abnormal cervical or vaginal discharge, and severe vitamin A deficiency.
The presence of human immunodeficiency virus type 1 (HIV-1) in genital secretions may be a determinant of vertical HIV-1 transmission. Cervical and vaginal secretions from HIV-1-seropositive pregnant women were evaluated to determine prevalence and correlates of HIV-1-infected cells in the genital tract. HIV-1 DNA was detected by polymerase chain reaction in 32% of 212 cervical and 10% of 215 vaginal specimens. Presence of HIV-1 DNA in the cervix was associated with cervical mucopus and a significantly lower absolute CD4 cell count (354 vs. 469, P < .001). An absolute CD4 cell count <200 was associated with a 9.6-fold increased odds of cervical HIV-1 DNA detection compared with a count > or = 500 (95% confidence interval, 2.8-34.2). Detection of vaginal HIV- 1 DNA was associated with abnormal vaginal discharge, lower absolute CD4 cell count, and severe vitamin A deficiency. Presence of HIV-1-infected cells in genital secretions was associated with immunosuppression and abnormal cervical or vaginal discharge.
John
G C
GC
Department of Pediatrics, University of Nairobi, Kenya.
Nduati
R W
RW
Mbori-Ngacha
D
D
Overbaugh
J
J
Welch
M
M
Richardson
B A
BA
Ndinya-Achola
J
J
Bwayo
J
J
Krieger
J
J
Onyango
F
F
Kreiss
J K
JK
D000293:Adolescent; D000328:Adult; D018791:CD4 Lymphocyte Count; D016516:CD4-CD8 Ratio; D016022:Case-Control Studies; D002584:Cervix Uteri / Q000821:virology; D015331:Cohort Studies; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D005836:Genitalia, Female / Q000821:virology*; D015658:HIV Infections / Q000150:complications / Q000276:immunology / Q000635:transmission / Q000821:virology*; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D008895:Milk, Human / Q000821:virology; D016017:Odds Ratio; D016133:Polymerase Chain Reaction; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000276:immunology / Q000821:virology*; D014621:Vagina / Q000821:virology; D019522:Vaginal Discharge / Q000150:complications / Q000821:virology*; D017201:Virus Shedding; D014802:Vitamin A Deficiency / Q000150:complications*
D004279:DNA, Viral