Factors associated with nucleic acids related to human immunodeficiency virus type 1 in cervico-vaginal secretions.
OBJECTIVE
To assess HIV-related nucleic acids in cervico-vaginal secretions and the factors associated with them.


METHODS
Observational study.


METHODS
Department of Obstetrics and Gynaecology, University of Pavia, Italy.


METHODS
HIV-positive patients attending a cytology service.


METHODS
Paired blood and cervico-vaginal lavage samples were obtained from 122 known HIV-seropositive patients during periodic visits for cytologic screening for lower genital tract neoplasia. Vaginal specimens for the diagnosis of bacterial vaginosis, trichomonas vaginalis and candida infection were also obtained. HIV-1-RNA in plasma, proviral HIV-1-DNA, cell associated and cell-free HIV-1 RNA in cervico-vaginal secretions were quantitatively evaluated by competitive polymerase chain reaction (c-PCR) and reverse transcriptase PCR (cRT-PCR).


METHODS
Prevalences of HIV related nucleic acids in cervico-vaginal secretions and their univariate and multivariate associations with clinical variables.


RESULTS
Proviral HIV-1 DNA, cell-associated and cell-free HIV-1 RNA were detected in 50% (61/122), 37.7% (46/122) and 32.8% (40/122) of the patients, respectively. In logistic regression analysis, the presence of HIV-1 RNA in blood was the factor which correlated best with the detection of HIV-1 DNA (OR = 5.48, 95% CI = 2.28-13.20), cell-associated (OR = 4.85; 95% CI = 1.89-12.45) and cell-free HIV-1 RNA (OR = 4.63, 95% CI = 1.74-12.33) in cervico-vaginal samples. However, between 20% and to 35% of patients who tested negative for blood HIV-1 RNA were positive for either HIV-1 DNA or HIV-1 RNA detection in cervico-vaginal lavages. Bacterial vaginosis was associated with an increased prevalence of cell-associated (OR = 3.58, 95% CI = 1.22-10.54) and cell-free HIV-1 RNA (OR = 2.94, 95% CI = 1.0-8.7) detection in cervico-vaginal secretions. Additional factors associated with increased prevalence of HIV-1 RNA detection were advanced stage of HIV disease and vulvovaginal candidiasis.


CONCLUSIONS
Although the presence of HIV-1 RNA in blood is the factor which correlates best with the detection of HIV-related nucleic acids in cervico-vaginal secretions, the shedding of HIV in the genital tract can occur in 20-30% of non-viremic subjects. Bacterial vaginosis and candida infection could have a facilitating role in local HIV viral replication and shedding.
Spinillo
A
A
Department of Obstetrics and Gynaecology, University of Pavia, Italy.
Debiaggi
M
M
Zara
F
F
Maserati
R
R
Polatti
F
F
De Santolo
A
A
D000328:Adult; D002584:Cervix Uteri / Q000378:metabolism; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004279:DNA, Viral / Q000032:analysis*; D005260:Female; D015658:HIV Infections / Q000378:metabolism*; D006679:HIV Seropositivity / Q000821:virology*; D015497:HIV-1 / Q000737:chemistry*; D006801:Humans; D012367:RNA, Viral / Q000032:analysis* / Q000097:blood; D014621:Vagina / Q000378:metabolism*
D004279:DNA, Viral; D012367:RNA, Viral