title: Determinants of HIV-1 shedding in the genital tract of women.
abstract: BACKGROUND
  Plasma HIV-1 RNA concentration has been the best predictor for risk of heterosexual and perinatal transmission. However, direct contact with HIV-1 present locally in the genital tract might be necessary for transmission. We aimed to assess the relation between HIV-1 shedding (RNA or culturable virus) in female genital secretions and other factors that might affect HIV-1 shedding.
  
  
  METHODS
  This was a cross-sectional study within the Women's Interagency HIV Study (WIHS), a prospective longitudinal cohort study of HIV-infected women. We enrolled 311 HIV positive women from Jan 30, 1997 to July 1, 1998. We did clinical assessments, cultured HIV-1, and measured RNA in peripheral blood mononuclear cells (PBMC) and genital secretions. We compared the results with univariate and multivariate analyses. Presence of HIV-1 RNA or culturable virus in genital secretions was defined as HIV-1 shedding.
  
  
  RESULTS
  HIV-1 RNA was present in genital secretions of 57% (152/268) of women whereas infectious virus was detected only in 6% (17/271). Genital tract HIV-1 shedding was found in 80% (130/163) of women with detectable plasma RNA and 78% (116/148) of women with positive PBMC cultures. 33% (27/83) of women with less than 500 copies/mL plasma RNA and 39% (35/90) of those with negative PBMC cultures also had genital tract shedding.
  
  
  CONCLUSIONS
  Plasma RNA concentration, both qualitatively and quantitatively, was the most important factor in predicting genital HIV-1 shedding, even among women receiving potent antiretroviral therapy. However, HIV-1 shedding did occur in women with less than 500 copies/mL plasma HIV-1 RNA. This finding suggests that a separate reservoir of HIV-1 replication may exist in some women.
authors.affiliation: Maternal-Child and Adolescent HIV Management and Research Center, University of Southern California School of Medicine, Los Angeles, CA 90033, USA. akovacs@hsc.usc.edu
authors.forename: A
authors.initials: A
authors.lastname: Kovacs
authors.forename: S S
authors.initials: SS
authors.lastname: Wasserman
authors.forename: D
authors.initials: D
authors.lastname: Burns
authors.forename: D J
authors.initials: DJ
authors.lastname: Wright
authors.forename: J
authors.initials: J
authors.lastname: Cohn
authors.forename: A
authors.initials: A
authors.lastname: Landay
authors.forename: K
authors.initials: K
authors.lastname: Weber
authors.forename: M
authors.initials: M
authors.lastname: Cohen
authors.forename: A
authors.initials: A
authors.lastname: Levine
authors.forename: H
authors.initials: H
authors.lastname: Minkoff
authors.forename: P
authors.initials: P
authors.lastname: Miotti
authors.forename: J
authors.initials: J
authors.lastname: Palefsky
authors.forename: M
authors.initials: M
authors.lastname: Young
authors.forename: P
authors.initials: P
authors.lastname: Reichelderfer
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D005836:Genitalia, Female / Q000821:virology*; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014777:Virus Diseases / Q000175:diagnosis / Q000453:epidemiology; D017201:Virus Shedding
chemical_list: D012367:RNA, Viral