title: The effect of vaginal candidiasis on the shedding of human immunodeficiency virus in cervicovaginal secretions.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the influence of symptomatic vulvovaginal candidiasis on the shedding of HIV-1 in cervicovaginal secretions of HIV-1-infected women.
  
  
  METHODS
  We obtained paired blood and cervicovaginal lavage samples from 66 HIV-infected women with symptomatic vulvovaginal candidiasis, and 249 HIV-infected control patients without genital infection. HIV-1 RNA in plasma, proviral HIV-1 DNA, HIV-1 RNA transcripts, and cell-free HIV-1 RNA in cervicovaginal secretions were quantitatively evaluated by competitive polymerase chain reaction (cPCR) and reverse transcriptase PCR (cRT-PCR). We used logistic regression on ordered data to assess the influence of vulvovaginal candidiasis on the HIV-1 load in cervicovaginal secretions adjusting for potential confounders.
  
  
  RESULTS
  Overall, the amount of HIV-1 RNA in plasma was significantly correlated with HIV-1 DNA (Spearman rank 0.153 +/- 0.059, P = .006), HIV-1 RNA transcripts (Spearman rank 0.169 +/- 0.058, P = .003), and cell free HIV-1 RNA (Spearman rank 0.185 +/- 0.059, P = .001) load in cervicovaginal secretion. Forty-eight out of 182 (26.4%) patients who tested negative for HIV-1 RNA in plasma were positive for HIV-DNA in their cervicovaginal secretions. In logistic regression analysis vulvovaginal candidiasis was significantly associated with increasing loads of HIV-1 RNA transcripts (Odds ratio [OR] 1.97, 95% CI 1.09-3.57, P = .025) and cell free HIV-1 RNA (OR 2.03, 95% CI 1.10-3.73, P = .02) in cervicovaginal secretions.
  
  
  CONCLUSIONS
  In HIV-infected women, vulvovaginal candidiasis is associated with an increased number of copies of cell-associated and cell-free HIV-1 RNA in cervicovaginal secretions.
authors.affiliation: Department of Obstetrics and Gynecology, University of Pavia, IRCCS Policlinico S. Matteo, Pavia, Italy. spinillo@smatteo.pv.it
authors.forename: Arsenio
authors.initials: A
authors.lastname: Spinillo
authors.forename: Francesca
authors.initials: F
authors.lastname: Zara
authors.forename: Barbara
authors.initials: B
authors.lastname: Gardella
authors.forename: Eleonora
authors.initials: E
authors.lastname: Preti
authors.forename: Roberta
authors.initials: R
authors.lastname: Mainini
authors.forename: Renato
authors.initials: R
authors.lastname: Maserati
mesh_terms: D012634:Bodily Secretions / Q000821:virology; D002181:Candidiasis, Vulvovaginal / Q000150:complications* / Q000821:virology*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000821:virology*; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D016133:Polymerase Chain Reaction; D012367:RNA, Viral / Q000032:analysis* / Q000097:blood; D014621:Vagina / Q000378:metabolism*
chemical_list: D012367:RNA, Viral