Hormonal contraception, vitamin A deficiency, and other risk factors for shedding of HIV-1 infected cells from the cervix and vagina.
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.
Mostad
S B
SB
Department of Epidemiology, University of Washington, Seattle 98195, USA.
Overbaugh
J
J
DeVange
D M
DM
Welch
M J
MJ
Chohan
B
B
Mandaliya
K
K
Nyange
P
P
Martin
H L
HL
Ndinya-Achola
J
J
Bwayo
J J
JJ
Kreiss
J K
JK
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*
D003278:Contraceptives, Oral, Hormonal; D004279:DNA, Viral