title: Identification of modifiable factors that affect the genetic diversity of the transmitted HIV-1 population.
abstract: BACKGROUND
  Our previous studies have shown that the majority of African women were infected with multiple HIV-1 genetic variants, while in the remaining women only a single viral genotype was detected early in infection. Infection with multiple viral variants was associated with higher plasma HIV-1 RNA levels and faster CD4 T-cell decline.
  
  
  METHODS
  Socio-behavioral characteristics, use of hormonal contraceptives, and the presence of sexually transmitted diseases were prospectively assessed at approximately monthly intervals around the time of HIV-1 acquisition in female sex workers in Kenya. We assessed the relationship between these factors and HIV-1 genetic complexity early in infection.
  
  
  RESULTS
  One hundred and fifty-six women were included in this analysis, of whom 89 had multiple viral genotypes and 67 had a single genotype at primary infection. Women with multiple variants were more likely to have a genital tract infection [odds ratio (OR), 4.7; 95% confidence interval (CI), 1.4-18.1] or to be using hormonal contraceptives (OR, 2.7; 95% CI, 1.3-5.6) at the time of their infection than those with a single variant. In multivariate analyses, these factors were independent predictors of early HIV-1 genetic complexity, and the presence of multiple viral variants early in infection remained significantly associated with a higher steady state plasma HIV-1 RNA level.
  
  
  CONCLUSIONS
  The presence of genital tract infections and hormonal contraceptive use at the time of transmission were associated with the acquisition of multiple HIV-1 variants.
authors.affiliation: Division of Human Biology, Fred Hutchinson Cancer Research Center, University of Washington, 1100 Fairview Avenue, Seattle, WA 98109, USA.
authors.forename: Manish
authors.initials: M
authors.lastname: Sagar
authors.forename: Ludo
authors.initials: L
authors.lastname: Lavreys
authors.forename: Jared M
authors.initials: JM
authors.lastname: Baeten
authors.forename: Barbra A
authors.initials: BA
authors.lastname: Richardson
authors.forename: Kishorchandra
authors.initials: K
authors.lastname: Mandaliya
authors.forename: Jeckoniah O
authors.initials: JO
authors.lastname: Ndinya-Achola
authors.forename: Joan K
authors.initials: JK
authors.lastname: Kreiss
authors.forename: Julie
authors.initials: J
authors.lastname: Overbaugh
mesh_terms: D000328:Adult; D003278:Contraceptives, Oral, Hormonal; D004812:Epidemiologic Methods; D005260:Female; D014644:Genetic Variation; D005831:Genital Diseases, Female / Q000150:complications; D005838:Genotype; D015658:HIV Infections / Q000150:complications / Q000635:transmission / Q000821:virology*; D015497:HIV-1 / Q000145:classification / Q000235:genetics*; D006801:Humans; D008875:Middle Aged; D011477:Sex Work; D012749:Sexually Transmitted Diseases / Q000150:complications; D019562:Viral Load
chemical_list: D003278:Contraceptives, Oral, Hormonal