The associations between cervicovaginal HIV shedding, sexually transmitted diseases and immunosuppression in female sex workers in Abidjan, Côte d'Ivoire.
OBJECTIVE
To measure the frequency and associated factors of cervicovaginal HIV shedding and to determine the impact of sexually transmitted disease (STD) treatment on HIV shedding.


METHODS
Cross-sectional study with 1-week follow-up.


METHODS
Confidential clinic for female sex workers in Abidjan, Côte d'Ivoire.


METHODS
A total of 1201 female sex workers.


METHODS
STD treatment based on clinical signs.


METHODS
HIV serostatus; cervicovaginal HIV shedding at enrollment and at 1-week follow-up; STD status at enrollment and at 1-week follow-up.


RESULTS
Cervicovaginal shedding of HIV-1 in HIV-1-seropositive women was more frequent (96 out of 404, 24%) than shedding of HIV-2 in HIV-2-seropositive women [one out of 21, 5%; odds ratio (OR), 6.2; 95% confidence interval (CI), 1.0-261]. Among 609 HIV-1-seropositive or dually seroreactive women, HIV-1 shedding was significantly more frequent in immunosuppressed women [adjusted OR (AOR), 6.3; 95% CI, 3.4-11.9; and AOR, 2.9; 95% CI, 1.6-5.0 for CD4 < 14% and CD4 14-28%, respectively, versus CD4 > 28%], and in women with Neisseria gonorrhoeae (AOR, 1.9; 95% CI, 1.2-3.0), those with Chlamydia trachomatis (AOR, 2.5; 95% CI, 1.1-5.8), and with a cervical or vaginal ulcer (AOR, 3.9; 95% CI, 2.1-7.4). HIV-1 shedding decreased from 42 to 21% (P < 0.005) in women whose STD were cured.


CONCLUSIONS
These data help to explain the difference in transmissibility between HIV-1 and HIV-2 and the increased infectiousness of HIV in the presence of immunosuppression and STD. In addition, they lend biological plausibility to arguments for making STD control an integral part of HIV prevention strategies in Africa.
Ghys
P D
PD
Projet RETRO-CI, Abidjan, Côte d'Ivoire.
Fransen
K
K
Diallo
M O
MO
Ettiègne-Traoré
V
V
Coulibaly
I M
IM
Yeboué
K M
KM
Kalish
M L
ML
Maurice
C
C
Whitaker
J P
JP
Greenberg
A E
AE
Laga
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D002584:Cervix Uteri / Q000821:virology*; D007560:Cote d'Ivoire / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006679:HIV Seropositivity / Q000276:immunology / Q000821:virology*; D015497:HIV-1 / Q000276:immunology; D015498:HIV-2 / Q000276:immunology; D006801:Humans; D007108:Immune Tolerance; D008875:Middle Aged; D015995:Prevalence; D011477:Sex Work; D015229:Sexually Transmitted Diseases, Viral / Q000453:epidemiology / Q000276:immunology / Q000821:virology*; D014621:Vagina / Q000821:virology*; D019562:Viral Load; D017201:Virus Shedding / Q000276:immunology