title: Cell-associated genital tract virus and vertical transmission of human immunodeficiency virus type 1 in antiretroviral-experienced women.
abstract: To determine the association between genital tract shedding of human immunodeficiency virus (HIV) type 1 and vertical transmission, a case-control substudy was conducted within the Women and Infants Transmission Study. Antenatal cervicovaginal lavage specimens were assessed for HIV-1 RNA in the supernatant and HIV-1 RNA and DNA in cell pellets. Multivariate analyses compared 26 women who transmitted HIV to their infants with 52 women who did not; 33% received combination antiretroviral therapy, and 65% received monotherapy. Adjusted odds ratios (ORs) for the presence (OR, 3.42; 95% confidence interval [CI], 0.76-15.4; P=.11) and titer (OR, 1.66; 95% CI, 0.93-2.99; P=.09) of HIV-1 DNA suggested that there is an independent association with vertical transmission. When analyses were restricted to vaginal and nonelective cesarean deliveries, each one-log increase in mean titer of HIV-1 DNA was associated with a significantly higher risk of transmission (OR, 2.28; 95% CI, 1.09-4.78; P=.03). The cell-associated genital tract compartment is important in the pathophysiology and prevention of vertical HIV-1 transmission.
authors.affiliation: Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. rtuomala@partners.org
authors.forename: Ruth E
authors.initials: RE
authors.lastname: Tuomala
authors.forename: Peter T
authors.initials: PT
authors.lastname: O'Driscoll
authors.forename: James W
authors.initials: JW
authors.lastname: Bremer
authors.forename: Cheryl
authors.initials: C
authors.lastname: Jennings
authors.forename: Chong
authors.initials: C
authors.lastname: Xu
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Read
authors.forename: Elaine
authors.initials: E
authors.lastname: Matzen
authors.forename: Alan
authors.initials: A
authors.lastname: Landay
authors.forename: Carmen
authors.initials: C
authors.lastname: Zorrilla
authors.forename: William
authors.initials: W
authors.lastname: Blattner
authors.forename: Manhattan
authors.initials: M
authors.lastname: Charurat
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Anderson
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D002584:Cervix Uteri / Q000166:cytology / Q000821:virology; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D005836:Genitalia, Female / Q000166:cytology / Q000821:virology*; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy* / Q000635:transmission* / Q000821:virology; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D016017:Odds Ratio; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000821:virology*; D012367:RNA, Viral / Q000032:analysis; D012307:Risk Factors; D014621:Vagina / Q000166:cytology / Q000821:virology; D017201:Virus Shedding
chemical_list: D019380:Anti-HIV Agents; D004279:DNA, Viral; D012367:RNA, Viral