Treatment of cervicitis is associated with decreased cervical shedding of HIV-1.
OBJECTIVE
To determine whether cervical mucosal shedding of HIV-1 RNA and HIV-1 infected cells decreases following successful treatment of cervicitis.


METHODS
Prospective interventional study.


METHODS
Sexually Transmitted Infections Clinic, Coast Provincial General Hospital, Mombasa, Kenya.


METHODS
Thirty-six HIV-1 seropositive women with cervicitis: 16 with Neisseria gonorrhoeae, seven with Chlamydia trachomatis, and 13 with non-specific cervicitis.


METHODS
Treatment of cervicitis.


METHODS
Levels of total (cell-free and cell-associated) HIV-1 RNA and presence of HIV-1 DNA (a marker for infected cells) in cervical secretions before and after resolution of cervicitis.


RESULTS
After treatment of cervicitis, the median HIV-1 RNA concentration in cervical secretions was reduced from 4.05 to 3.24 log10 copies/swab (P = 0.001). Significant decreases in cervical HIV-1 RNA occurred in the subgroups with N. gonorrhoeae (3.94 to 3.28 log10 copies/swab; P = 0.02) and C. trachomatis (4.21 to 3.19 log10 copies/swab; P = 0.02). Overall, the prevalence of HIV-1 infected cells in cervical secretions also decreased after treatment, from 67% to 42% (odds ratio, 2.8; 95% confidence interval, 1.3-6.0; P = 0.009). Detection of infected cells was associated with higher mean HIV-1 RNA levels (4.04 versus 2.99 log10 copies/swab; P< 0.0001).


CONCLUSIONS
Effective treatment of cervicitis resulted in significant decreases in shedding of HIV-1 virus and infected cells in cervical secretions. Treatment of sexually transmitted diseases may be an important means of decreasing the infectivity of HIV-1 seropositive women by reducing exposure to HIV-1 in genital secretions.
Mcclelland
R S
RS
Department of Medicine, University of Washington, Seattle 98104, USA.
Wang
C C
CC
Mandaliya
K
K
Overbaugh
J
J
Reiner
M T
MT
Panteleeff
D D
DD
Lavreys
L
L
Ndinya-Achola
J
J
Bwayo
J J
JJ
Kreiss
J K
JK
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology; D000328:Adult; D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents / Q000627:therapeutic use; D002584:Cervix Uteri / Q000276:immunology / Q000821:virology*; D002690:Chlamydia Infections / Q000188:drug therapy* / Q000821:virology; D002692:Chlamydia trachomatis; D005260:Female; D006069:Gonorrhea / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012367:RNA, Viral / Q000378:metabolism; D002575:Uterine Cervicitis / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology; D017201:Virus Shedding / Q000187:drug effects*; D016387:Women's Health
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D012367:RNA, Viral