title: Hormonal contraception, vitamin A deficiency, and other risk factors for shedding of HIV-1 infected cells from the cervix and vagina.
abstract: BACKGROUND
  Factors that influence shedding of HIV-1 infected cells in cervical and vaginal secretions may be important determinants of sexual and vertical transmission of the virus. We investigated whether hormonal contraceptive use, vitamin A deficiency, and other variables were risk factors for cervical and vaginal shedding of HIV-infected cells.
  
  
  METHODS
  Between December, 1994, and April, 1996, women who attended a municipal sexually transmitted diseases (STDs) clinic in Mombasa, Kenya, and had previously tested positive for HIV-1, were invited to take part in our cross-sectional study. Cervical and vaginal secretions from 318 women were evaluated for the presence of HIV-1 infected cells by PCR amplification of gag DNA sequences.
  
  
  RESULTS
  HIV-1 infected cells were detected in 51% of endocervical and 14% of vaginal-swab specimens. Both cervical and vaginal shedding of HIV-1 infected cells were highly associated with CD4 lymphocyte depletion (p = 0.00001 and p = 0.003, respectively). After adjustment for CD4 count, cervical proviral shedding was significantly associated with use of depot medroxyprogesterone acetate (odds ratio 2.9, 95% CI 1.5-5.7), and with use of low-dose and high-dose oral contraceptive pills (3.8, 1.4-9.9 and 12.3, 1.5-101, respectively). Vitamin A deficiency was highly predictive of vaginal HIV-1 DNA shedding. After adjustment for CD4 count, severe vitamin A deficiency, moderate deficiency, and low normal vitamin A status were associated with 12.9, 8.0, and 4.9-fold increased odds of vaginal shedding, respectively. Gonococcal cervicitis (3.1, 1.1-9.8) and vaginal candidiasis (2.6, 1.2-5.4) were also correlated with significant increases in HIV-1 DNA detection, but Chlamydia trachomatis and Trichomonas vaginalis were not.
  
  
  CONCLUSIONS
  Our study documents several novel correlates of HIV-1 shedding in cervical and vaginal secretions, most notably hormonal contraceptive use and vitamin A deficiency. These factors may be important determinants of sexual or vertical transmission of HIV-1 and are of public health importance because they are easily modified by simple interventions.
authors.affiliation: Department of Epidemiology, University of Washington, Seattle 98195, USA.
authors.forename: S B
authors.initials: SB
authors.lastname: Mostad
authors.forename: J
authors.initials: J
authors.lastname: Overbaugh
authors.forename: D M
authors.initials: DM
authors.lastname: DeVange
authors.forename: M J
authors.initials: MJ
authors.lastname: Welch
authors.forename: B
authors.initials: B
authors.lastname: Chohan
authors.forename: K
authors.initials: K
authors.lastname: Mandaliya
authors.forename: P
authors.initials: P
authors.lastname: Nyange
authors.forename: H L
authors.initials: HL
authors.lastname: Martin
authors.forename: J
authors.initials: J
authors.lastname: Ndinya-Achola
authors.forename: J J
authors.initials: JJ
authors.lastname: Bwayo
authors.forename: J K
authors.initials: JK
authors.lastname: Kreiss
mesh_terms: D000293:Adolescent; D000328:Adult; D002584:Cervix Uteri / Q000187:drug effects / Q000821:virology*; D003278:Contraceptives, Oral, Hormonal / Q000494:pharmacology*; D003430:Cross-Sectional Studies; D004279:DNA, Viral / Q000302:isolation & purification*; D005260:Female; D015658:HIV Infections / Q000635:transmission*; D006679:HIV Seropositivity; D015497:HIV-1 / Q000276:immunology / Q000302:isolation & purification*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D007630:Kenya; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012307:Risk Factors; D015231:Sexually Transmitted Diseases, Bacterial / Q000175:diagnosis; D014621:Vagina / Q000187:drug effects / Q000821:virology*; D014802:Vitamin A Deficiency / Q000821:virology*
chemical_list: D003278:Contraceptives, Oral, Hormonal; D004279:DNA, Viral